Laxative

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Laxatives (purgatives, aperients) are foods, compounds or drugs taken to loosen the stool, most often taken to treat constipation. Certain stimulant, lubricant and saline laxatives are used to evacuate the colon for rectal and/or bowel examinations, and may be supplemented by enemas under certain circumstances. Sufficiently high doses of laxatives may cause diarrhea. Laxatives work to increase the movement of feces along the colon.[1]

Some laxatives combine more than one active ingredient. Laxatives may be oral or in suppository form.

Contents

Foods

Foods that help with laxation include fruits, especially banana,[2] kiwifruit[3] and prunes,[4] bran products, aloe vera, blackstrap molasses, pear and nuts (especially almonds and walnuts).[5]

Bulk-producing agents

A bulk-forming agent is a substance, such as fiber in food, that adds bulk and water to stools so that they can pass more easily through the intestines (lower part of the digestive tract).[6]

Also known as bulking agents or roughage, these include insoluble dietary fibre. 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

These enable additional water and fats to be incorporated in the stool, making it easier to move.

Lubricants or emollient

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 and some minerals.

Hydrating agents (osmotics)

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

Saline

Saline laxatives attract and retain water in the intestinal lumen, increasing intraluminal pressure and thus softening the stool. They 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.

Hyperosmotic agents

Lactulose works by the osmotic effect, which retains water in the colon, lowering the pH through bacterial fermentation to lactic, formic and acetic acid, 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, Miralax, NuLytely, SUPREP, Fortrans and others.

Effectiveness

For adults, a randomized controlled trial found PEG [MiraLax or GlycoLax] 17 grams once per day to be superior to tegaserod at 6 mg twice per day.[7] A randomized controlled trial found greater improvement from 2 sachets (26 grams) of PEG versus 2 sachets (20 grams) of lactulose.[8] 17 grams/day of PEG has been effective and safe in a randomized controlled trial for six months.[9] Another randomized controlled trial found no difference between sorbitol and lactulose.[10]

For children, PEG was found to be more effective than lactulose.[11]

Stimulant or irritant

Stimulant laxatives act on the intestinal mucosa or nerve plexus, altering water and electrolyte secretion. They also stimulate peristaltic action and can be dangerous under certain circumstances.[12] They are the most powerful among laxatives and should be used with care.

Common Stimulant Laxatives[13][14]
Preparation(s)TypeSite of ActionOnset of
Cascara (casanthranol)Anthraquinonecolon36–8 hours
BuckthornAnthraquinonecolon36–8 hours
Senna extract (senokot)Anthraquinonecolon36–8 hours
Aloe vera (aloin)Anthraquinonecolon58–10 hours
PhenolphthaleinTriphenylmethanecolon48 hours
Dulcolax (bisacodyl) (PO)Triphenylmethanecolon66–12 hours
Dulcolax (bisacodyl) (suppository)Triphenylmethanecolon160 minutes
Microlaxenemarectum and colon015–60 minutes
Castor oilricinoleic acidsmall intestine22–6 hours

Serotonin agonist

These are motility stimulants that work through activation of 5-HT4 receptors of the enteric nervous system in the gastrointestinal tract. However, some have been discontinued or restricted due to potentially harmful cardiovascular side-effects.

Tegaserod (brand name Zelnorm) was discontinued from marketing in the United States on March 30, 2007. It is still available to physicians for patients in emergency situations that are life-threatening or require hospitalization.[15]

Cisapride (brand name Prepulsid) was voluntarily removed from the U.S. market on July 14, 2000 for the same reason as Tegaserod. Its use in many other countries is discontinued or restricted. It is still available for veterinary use as a compound to treat GI tract problems.

Prucalopride (brand name Resolor) is a current drug which was approved for use in the EU October 15, 2009[16] and in Canada (brand name Resotran) on December 7, 2011.[17] It has not been approved by the Food and Drug Administration for use in the United States, but it is in development by Shire PLC.[18]

Chloride channel activators

Lubiprostone (brand name Amitiza) is used in the management of chronic idiopathic constipation and irritable bowel syndrome. It causes the intestines to produce a chloride-rich fluid secretion which soften the stool, increases motility, and promotes spontaneous bowel movements (SBM).

Uses

Problems with use

Laxative abuse

Laxative abuse is potentially serious since it can lead to intestinal paralysis,[citation needed] irritable bowel syndrome (IBS),[19] pancreatitis,[citation needed] renal failure,[20][21] factitious diarrhea[22] and other problems, even though recovery is possible with proper treatment.[23]

Laxative gut

Physicians warn against the chronic use of stimulant laxatives due to concern that chronic use causes the colonic tissues to get worn out over time and not be able to expel feces due to long term overstimulation.[citation needed] A common finding in patients who have used stimulant laxatives is a brown pigment deposited in the intestinal tissue, known as melanosis coli.[citation needed]

Historical & non-mainstream medical use

Laxatives, then called physicks or purgatives, were used extensively in pre-modern medicine to treat a wide range of conditions for which they are now generally regarded as ineffective in modern evidence-based medicine.[citation needed] Similarly, laxatives (often termed colon cleanses), continue to be promoted by practitioners of complementary medicine for a range of conditions, including conditions which are not medically recognized, e.g. mucoid plaque.[citation needed]

See also

References

  1. ^ "What is a Laxative and Do Natural Laxatives Work?". Articlesbase. 5 May 2008. http://www.articlesbase.com/supplements-and-vitamins-articles/what-is-a-laxative-and-do-natural-laxatives-work-404326.html. Retrieved 10 October 2012.
  2. ^ Das, JL (2010). "Medicinal and nutritional values of banana cv. NENDRAN". Asian Journal of Horticulture 8: 11–14. http://www.cabdirect.org/abstracts/20103272020.html;jsessionid=2B9A2FDF37186F0DA0A347FF227D606D.
  3. ^ Rush EC, Patel M, Plank LD, Fergus LR (2002). "Kiwifruit promotes laxation in the elderly.". Asia Pac J Clin Nutr 11 (2): 164–8. doi:10.1046/j.1440-6047.2002.00287.x. PMID 12074185.
  4. ^ Stacewicz-Sapuntzakis, M; Bowen, PE; Hussain, EA; Damayanti-Wood, BI; Farnsworth, NR (2001). "Chemical composition and potential health effects of prunes: a functional food?". Critical reviews in food science and nutrition 41 (4): 251–86. doi:10.1080/20014091091814. PMID 11401245.
  5. ^ "Natural Laxative Foods". Spiritfoods. http://spiritfoods.net/natural-laxative-foods/. Retrieved 10 October 2012.
  6. ^ Bulk-forming agent entry in the public domain NCI Dictionary of Cancer Terms
  7. ^ 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.
  8. ^ 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. doi:10.1136/gut.44.2.226. PMC 1727381. PMID 9895382. //www.ncbi.nlm.nih.gov/pmc/articles/PMC1727381/.
  9. ^ 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.
  10. ^ 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. doi:10.1016/0002-9343(90)90177-F. PMID 2122724.
  11. ^ "BestBETs: Is polyethylene glycol safe and effective for chro...". http://www.bestbets.org/cgi-bin/bets.pl?record=00901. Retrieved 2007-09-06.
  12. ^ 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. doi:10.1097/00004836-199806000-00014. PMID 9649012.
  13. ^ Dharmananda, Subhuti. "SAFETY ISSUES AFFECTING HERBS: How Long can Stimulant Laxatives be Used?". Institute for Traditional Medicine. http://www.itmonline.org/arts/laxatives.htm. Retrieved 2010-03-19.
  14. ^ "Stimulant Laxatives". Family Practice Notebook, LLC. 2010-02-26. http://www.fpnotebook.com/GI/Pharm/StmlntLxtv.htm. Retrieved 2010-03-19.
  15. ^ Tegaserod, FDA Zelnorm (tegaserod maleate) Information
  16. ^ http://www.emea.europa.eu/docs/en_GB/document_library/EPAR_-_Summary_for_the_public/human/001012/WC500053995.pdf European Medicines Agency EPAR summary for the public]
  17. ^ [http://www.hc-sc.gc.ca/dhp-mps/prodpharma/sbd-smd/drug-med/sbd_smd_2012_resotran_141157-eng.php#a2 Health Canada, Notice of Decision for Resotran
  18. ^ http://www.shire.com/shireplc/en/rd/pipeline Shire PLC, R and D projects, Resolor
  19. ^ "Laxative Abuse: Some Basic Facts" (PDF). National Eating Disorders Association. 2005. http://www.nationaleatingdisorders.org/nedaDir/files/documents/handouts/Laxative.pdf. Retrieved 2008-09-07.
  20. ^ Copeland P; Molina, H.; Ohye, Ch.; MacIas, R.; Alaminos, A.; Alvarez, L.; Teijeiro, J.; Muñoz, J. et al. (1994). "Renal failure associated with laxative abuse". Psychother Psychosom 62 (3–4): 200–2. doi:10.1159/000098619. PMID 7531354.
  21. ^ Wright L, DuVal J (1987). "Renal injury associated with laxative abuse". South Med J 80 (10): 1304–6. doi:10.1097/00007611-198710000-00024. PMID 3660046.
  22. ^ Oster JR, Materson BJ, Rogers AI (November 1980). "Laxative abuse syndrome". Am. J. Gastroenterol. 74 (5): 451–8. PMID 7234824.
  23. ^ "Laxative overdose". Medline Plus. 15 December 2011. http://www.nlm.nih.gov/medlineplus/ency/article/002586.htm.