Laxatives

Information about Laxatives

Laxatives are foods, compounds, or drugs taken to induce bowel movements, most often taken to treat constipation. Certain stimulant, lubricant, and saline laxatives are used to evacuate the colon for rectal and bowel examinations. They are sometimes supplemented by enemas. Often, taking powerful laxatives can cause diarrhea, accompanied by massive flatulence attacks, due to the overworking of the bowels. Some people who experienced these side effects produced more than three times the average daily amount of flatulence in just one bowel release. Laxatives are often abused by people with eating disorders. Laxative abuse is potentially serious since it can lead to intestinal paralysis, Irritable Bowel Syndrome (IBS), pancreatitis, renal failure,<ref name-copeland>Copeland P (1994). "Renal failure associated with laxative abuse". Psychother Psychosom 62 (3-4): 200-2. PMID 7531354. ^[1] and other problems.

There are several types of laxatives, listed below. Some laxatives combine more than one type of active ingredient to produce a combination of the effects mentioned. Laxatives may be oral or in suppository form.

Constipation with no known organic cause, i.e. no medical explanation, exhibits gender differences in prevalence: females are more often affected than males.^[2] Not surprisingly, some advertisers promote their brands as being more feminine and thereby tailor their message to the market. The way laxatives function in males and females, however, does not exhibit significant differences.

Tobacco smoking has a laxative effect. ^[3]

Bulk-producing agents

Site of Action: Small and large intestine
Onset of Action: 12 - 72 hours
Examples: psyllium husk (Metamucil), methylcellulose (Citrucel), polycarbophil, dietary fiber, apples

Also known as bulking agents or roughage, these include dietary fiber. Bulk-producing agents cause the stool to be bulkier and to retain more water, as well as forming an emollient gel, making it easier for peristaltic action to move it along. They should be taken with plenty of water. Bulk-producing agents have the gentlest of effects among laxatives and can be taken just for maintaining regular bowel movements.

Stool softeners / Surfactants

Site of Action: Small and large intestine
Onset of Action: 12 - 72 hours
Examples: docusate (Colace, Diocto)

These cause water & fats to penetrate the stool, making it easier to move along. Many of these quickly produce a tolerance effect and so become ineffective with prolonged use. Their strength is between that of the bulk producers and the stimulants, and they can be used for patients with occasional constipation or those with anorectal conditions for whom passage of a firm stool is painful.

Lubricants / Emollient

Site of Action: Colon
Onset of Action: 6 - 8 hours

These simply make the stool slippery, so that it slides through the intestine more easily. An example is mineral oil, which also retards colonic absorption of water, softening the stool. Mineral oil may decrease the absorption of fat-soluble vitamins (A, D, E and K).

Hydrating agents (osmotics)

These cause the intestines to concentrate more water within, softening the stool. There are two principal types, saline and hyperosmotic.

Saline

Site of Action: Small and large intestine
Onset of Action: 0.5 - 6 hours
Examples: Dibasic sodium phosphate, magnesium citrate, magnesium hydroxide (Milk of magnesia), magnesium sulfate, monobasic sodium phosphate, sodium biphosphate, Epsom salt

Saline laxatives attract and retain water in the intestinal lumen, increasing intraluminal pressure and thus softening the stool. They will also cause the release of cholecystokinin, which stimulates the digestion of fat and protein. Saline laxatives may alter a patient's fluid and electrolyte balance.

Sulfate salts are considered the most potent.

Hyperosmotic agents

Site of Action: Colon
Onset of Action: 0.5 - 3 hours
Examples: Glycerin suppositories, Sorbitol, Lactulose, and Polyethylene glycol (PEG).

Lactulose works by the osmotic effect, which retains water in the colon, lowering the pH and increasing colonic peristalsis. Lactulose is also indicated in Portal-systemic encephalopathy. Glycerin suppositories work mostly by hyperosmotic action, but also the sodium stearate in the preparation causes local irritation to the colon.

Solutions of polyethylene glycol and electrolytes (sodium chloride, sodium bicarbonate, potassium chloride, and sometimes sodium sulfate) are used for whole bowel irrigation, a process designed to prepare the bowel for surgery or colonoscopy and to treat certain types of poisoning. Brand names for these solutions include GoLytely, GlycoLax, CoLyte, NuLytely, and others.

Effectiveness

For adults, a randomized controlled trial found PEG [MiraLax or GlycoLax] 17 grams once per day better than tegaserod 6 mg twice per day.^[4] A randomized controlled trial found greater improvement from 2 sachets (26 grams) of PEG versus or 2 sachets (20 grams) of lactulose ^[5]. 17 grams/day of PEG has been effective and safe in a randomized controlled trial for six months.^[6] Another randomized controlled trial found no difference between sorbitol and lactulose ^[7].

For children, PEG was found to be more effective than lactulose.^[8]

Stimulant / Irritant

Site of Action: Colon
Examples:

Onset of Action	Laxative Name
6 - 8 hours	Cascara Phenolphthalein (Formerly in Ex-lax but phased out because of carcinogenicity concerns)
6 - 10 hours	Bisacodyl tablets (Dulcolax) Casanthranol Senna (Ex-lax) Aloe Vera
2 - 6 hours	Castor oil
15 min - 1 hour	Bisacodyl suppository Microlax

These stimulate peristaltic action and can be dangerous under certain circumstances. Long term use can lead to 'cathartic colon'.^[9] Stimulant laxatives act on the intestinal mucosa, or nerve plexus; they also alter water and electrolyte secretion. They are the most severe among laxatives and should be used only in extreme conditions. Castor oil may be preferred when more complete evacuation is required.

Castor oil

Site of Action: Small intestine

Castor oil acts directly on intestinal mucosa or nerve plexus and alters water and electrolyte secretion. It is converted into ricinoleic acid (the active component) in the gut.

Serotonin agonist

Tegaserod is a motility stimulant that works through activation of 5-HT₄ receptors of the enteric nervous system in the gastrointestinal tract.

References

1. ^ Wright L, DuVal J (1987). "Renal injury associated with laxative abuse". South Med J 80 (10): 1304-6. PMID 3660046.
2. ^ Chang L, Toner B, Fukudo S, Guthrie E, Locke G, Norton N, Sperber A (2006). "Gender, age, society, culture, and the patient's perspective in the functional gastrointestinal disorders". Gastroenterology 130 (5): 1435-46. PMID 16678557.
3. ^ Nicotine withdrawal symptoms:Constipation. helpwithsmoking.com (2005). Retrieved on 2007-06-29.
4. ^ Di Palma JA, Cleveland MV, McGowan J, Herrera JL (2007). "A randomized, multicenter comparison of polyethylene glycol laxative and tegaserod in treatment of patients with chronic constipation". Am. J. Gastroenterol. 102 (9): 1964–71. DOI:10.1111/j.1572-0241.2007.01365.x. PMID 17573794.
5. ^ Attar A, Lémann M, Ferguson A, Halphen M, Boutron M, Flourié B, Alix E, Salmeron M, Guillemot F, Chaussade S, Ménard A, Moreau J, Naudin G, Barthet M (1999). "Comparison of a low dose polyethylene glycol electrolyte solution with lactulose for treatment of chronic constipation.". Gut 44 (2): 226-30. PMID 9895382.
6. ^ Dipalma JA, Cleveland MV, McGowan J, Herrera JL (2007). "A randomized, multicenter, placebo-controlled trial of polyethylene glycol laxative for chronic treatment of chronic constipation". Am. J. Gastroenterol. 102 (7): 1436-41. DOI:10.1111/j.1572-0241.2007.01199.x. PMID 17403074.
7. ^ Lederle F, Busch D, Mattox K, West M, Aske D (1990). "Cost-effective treatment of constipation in the elderly: a randomized double-blind comparison of sorbitol and lactulose.". Am J Med 89 (5): 597-601. PMID 2122724.
8. ^ BestBETs: Is polyethylene glycol safe and effective for chro.... Retrieved on 2007-09-06.
9. ^ Joo J, Ehrenpreis E, Gonzalez L, Kaye M, Breno S, Wexner S, Zaitman D, Secrest K (1998). "Alterations in colonic anatomy induced by chronic stimulant laxatives: the cathartic colon revisited.". J Clin Gastroenterol 26 (4): 283-6. PMID 9649012.

External links

• • [ e] Major Drug Groups
Gastrointestinal tract (A)	Antacids • Antiemetics • H₂-receptor antagonists • Proton pump inhibitors • Laxatives • Antidiarrhoeals
Blood and blood forming organs (B)	Anticoagulants • Antiplatelets • Thrombolytics
Cardiovascular system (C)	Antiarrhythmics • Antihypertensives • Diuretics • Vasodilators • Antianginals • Beta blockers • Angiotensin converting enzyme inhibitors • Antihyperlipidemics
Skin (D)	Antipruritics
Reproductive system (G)	Hormonal contraception • Fertility agents • Selective estrogen receptor modulators • Sex hormones
Endocrine system (H)	Anti-diabetics • Corticosteroids • Sex hormones • Thyroid hormones
Infections and Infestations (J, P)	Antibiotics • Antivirals • Vaccines • Antifungals • Antiprotozoals • Anthelmintics
Malignant and Immune disease (L)	Anticancer agents • Immunosuppressants
Muscles, Bones, and Joints (M)	Anabolic steroids • Anti-inflammatories • Antirheumatics • Corticosteroids • Muscle relaxants
Brain and Nervous system (N)	Anesthetics • Analgesics • Anticonvulsants • Mood stabilizers • Anxiolytics • Antipsychotics • Antidepressants • Nervous system stimulants
Respiratory system (R)	Bronchodilators • Decongestants • Antihistamines

• • [ e] Laxatives (A06)
Softeners, emollients	Paraffin - Docusate sodium
Contact laxatives	Oxyphenisatine - Bisacodyl - Dantron - Phenolphthalein - Castor oil - Senna glycosides - Cascara - Sodium picosulfate - Bisoxatin
Bulk producers	Ispaghula - Ethulose - Sterculia - Linseed - Methylcellulose - Triticum - Polycarbophil calcium
Osmotically acting laxatives	Magnesium carbonate - Magnesium oxide - Magnesium peroxide - Magnesium sulfate - Lactulose - Lactitol - Sodium sulfate - Pentaerithrityl - Macrogol - Mannitol - Sodium phosphate - Sorbitol - Magnesium citrate - Sodium tartrate
Enemas	Sodium phosphate - Bisacodyl - Dantron - Glycerol - Oil - Sorbitol

Constipation
Classification & external resources

ICD-10 K 59.0
ICD-9 564.0

DiseasesDB 3080
MedlinePlus 003125
eMedicine med/2833 Constipation or irregularity
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colon is another name for the large intestine. The main function of the colon appears to be extraction of water from feces. In mammals, it consists of the ascending colon, transverse colon, the descending colon, and the sigmoid colon.
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The rectum (from the Latin rectum intestinum, meaning straight intestine) is the final straight portion of the large intestine in some mammals, and the gut in others, terminating in the anus. The human rectum is about 12 cm long.
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enema (plural enemata or enemas) is the procedure of introducing liquids into the rectum and colon via the anus. Enemas can be carried out for medical reasons (as a treatment for constipation), as a remedy for encopresis, as part of alternative health therapies, and
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MeSH D003967 Diarrhea (in American English) or diarrhoea (in British English) is a condition in which the sufferer has frequent watery, loose bowel movements (from the Greek word διάρροια; literally meaning "through-flowing").
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In anatomy, the intestine is the segment of the alimentary canal extending from the stomach to the anus and, in humans and other mammals, consists of two segments, the small intestine and the large intestine.
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Irritable bowel syndrome synonymous with GILL/HT/IB
Classification & external resources

ICD-10 K 58.
ICD-9 564.1

DiseasesDB 30638
MedlinePlus 000246
eMedicine med/1190
MeSH D043183 In gastroenterology,
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Pancreatitis
Classification & external resources

ICD-10 K 85. , K 86.0 -K 86.1
ICD-9 577.0 - 577.1

eMedicine emerg/354 Pancreatitis is inflammation of the pancreas. See also acute pancreatitis and chronic pancreatitis for more details.
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MeSH C12.777.419.780.500 Renal failure or kidney failure is the condition in which the kidneys fail to function adequately.

Biochemically, it is typically detected by an elevated serum creatinine.
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In pharmacology and toxicology, a route of administration is the path by which a drug, fluid, poison or other substance is brought into contact with the body.^[1]
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suppository is a drug delivery system that is inserted either into the rectum (rectal suppository), vagina (vaginal suppository) or urethra (urethral suppository) where it dissolves. They are used to deliver both systemically-acting and locally-acting medications.
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An explanation is a statement which points to causes, , and consequences of some object, process, state of affairs, etc., together with rules or laws that link these to the object. Some of these of the explanation may be implicit.
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Gender", in common usage, refers to the differences between men and women. Encyclopaedia Britannica notes that gender identity is "an individual's self-conception as being male or female, as distinguished from actual biological sex.
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In epidemiology, the prevalence of a disease in a statistical population is defined as the total number of cases of the disease in the population at a given time, or the total number of cases in the population, divided by the number of individuals in the population.
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Tobacco smoking is the act of burning the dried or cured leaves of the tobacco plant and inhaling the smoke for pleasure, for ritualistic or social purposes, self-medication, or simply to satisfy physical dependence.
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Psyllium or Ispaghula is the common name used for several members of the plant genus Plantago whose seeds are used commercially for the production of mucilage.

History

The genus Plantago contains over 200 species. P. ovata and P.
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Metamucil is a bulk-producing laxative and fiber supplement manufactured by Procter & Gamble. The Metamucil brand has existed since 1934. The active ingredient is psyllium seed husks.
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Dietary fibers are the indigestible portion of plant foods that move food through the digestive system, absorbing water and making defecation easier. Dietary fiber consists of non-starch polysaccharides such as cellulose and many other plant components such as dextrins, inulin,
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Emollients are substances which soften and soothe the skin. They are used to correct dryness and scaling of the skin. They are a key component in the manufacture of lipstick, lotions and other cosmetic products.
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Peristalsis is the rhythmic contraction of smooth muscles to propel contents through the digestive tract. The word is derived from New Latin and comes from the Greek peristaltikos, peristaltic, from peristellein, "to wrap around," and stellein
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Docusate (IPA pronunciation: ['dɒkjuseɪt]) is the generic name of a surfactant used as a laxative and stool softener, which is sold in the U.S.
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Mineral oil or liquid petrolatum is a by-product in the distillation of petroleum to produce gasoline. It is a transparent, colorless oil composed mainly of alkanes (typically 15 to 40 carbons) [1] and cyclic paraffins, related to white petrolatum.
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A vitamin is a nutrient that is an organic compound required in tiny amounts for essential metabolic reactions in a living organism.^[1] The term vitamin
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Phosphates of sodium include:

trisodium phosphate
disodium hydrogen phosphate
sodium dihydrogen phosphate (monosodium phosphate)

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Magnesium citrate is a chemical agent used medicinally as a saline laxative and to empty the bowel prior to a surgery or colonoscopy. It is available over the counter, both as a generic brand or under the brand name Citromag.
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