Laxatives

Before prescribing laxatives it is important to be sure that the patient is constipated and that the constipation is not secondary to an underlying undiagnosed complaint. Thus, laxatives should generally be avoided except where straining will exacerbate a condition (such as angina) or increase the risk of rectal bleeding as in haemorrhoids. Laxatives are also of value in drug-induced constipation, for the expulsion of parasites after anthelmintic treatment, and to clear the alimentary tract before surgery and radiological procedures. Prolonged treatment of constipation is sometimes necessary. Laxatives should be prescribed by a healthcare professional experienced in the management of constipation in children. Delays of greater than 3 days between stools may increase the likelihood of pain on passing hard stools leading to anal fissure, anal spasm and eventually to a learned response to avoid defaecation. If dietary and lifestyle changes fail to control constipation in pregnancy, moderate doses of poorly absorbed laxatives may be used. A bulk-forming laxative should be tried first. An osmotic laxative, such as lactulose, can also be used. Bisacodyl or senna may be suitable, if a stimulant effect is necessary.

• Bulk Forming Drugs:

Bulk-forming laxatives relieve constipation by increasing faecal mass which stimulates peristalsis; patients should be advised that the full effect may take some days to develop. Bulk-forming laxatives are of particular value in those with small hard stools, but should not be required unless fibre cannot be increased in the diet. A balanced diet, including adequate fluid intake and fibre is of value in preventing constipation. Bulk-forming laxatives are useful in the management of patients with colostomy, ileostomy, haemorrhoids, anal fissure, chronic diarrhoea associated with diverticular disease, irritable bowel syndrome, and as adjuncts in ulcerative colitis.

Streculia / Frangula:

Dose and Administration:

Adults: 1-2 spoonfuls, washed down without chewing with plenty of liquid once

or twice daily. Child: 6-12 years half of the adult dose.

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Streculia:

Dose and Administration:

1-2 Sachets once or twice daily with full glass of water after meals.

Isphagula Seeds, Isphagula Husk & Senna Pods:

Dose and Administration:

One to two teaspoons in the evening to be repeated in the morning if required.

• Stimulant Laxatives:

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GLYCERIN (Glycerol)

Indications: -constipation, especially in children.

Dose and Administration: Rectally. The suppositories should be moistened with water before insertion. Adults, 2 – 4g suppository; Children، 2g suppository; Infants, 1g suppository.

BISACODYL:

Indications: This medication is used to treat constipation or to clean out the intestinal tract before bowel examinations or bowel surgery.

Contraindications: acute surgical abdominal conditions, acute inflammatory bowel disease, and severe dehydration.

Dose and Administration: Swallow the tablets whole with a full glass of water or juice. Do not crush or chew the tablets. The tablets should work within 6 to 10 hours. Do not take the tablets within one hour of taking any milk or dairy products. Severe stomach cramps and vomiting may occur. Bisacodyl should not be used longer than seven days without consulting your doctor. Prolonged use can lead to laxative dependence. Because this medication must be swallowed whole, do not give it to a child less than 6 years of age.

DOCUSATE SODIUM:

Indications: This medication is used to treat constipation or to clean out the intestinal tract before bowel examinations or bowel surgery.

Contraindications: should be avoided in intestinal obstruction.

Dose and Administration: for rectal administration adults, elderly and children over 12 years one enema enough. Children under 12 years not recommended.

• Osmotic Laxatives:

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Osmotic laxatives increase the amount of water in the large bowel, either by drawing fluid from the body into the bowel or by retaining the fluid they were administered with.

L:

Indications: constipation (may take up to 48 hours to act), hepatic encephalopathy (portal systemic encephalopathy).

Contraindications: galactosaemia, intestinal obstruction.

Dose and Administration: Constipation, initially 15 mL twice daily, adjusted according to patient’s needs; child (adjusted according to response) under 1 year 2.5 mL twice daily, 1–5 years 5 mL twice daily, 5–10 years 10 mL twice daily. Hepatic encephalopathy, 30–50 mL 3 times daily, subsequently adjusted to produce 2–3 soft stools daily.

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MACROGOLS (Polyethylene Glycols):

Indications: This medication is used to treat occasional constipation. It works by holding water in the stool to soften the stool and increases the number of bowel movements. It is known as an osmotic-type laxative.

Contraindications: intestinal perforation or obstruction, paralytic ileus, severe inflammatory conditions of the intestinal tract.

Dose and Administration: For chronic constipation adults 2-3 sachets daily in divided doses, elderly initially one sachet per day. Children not recommended. For fecal impaction adults 8 sachets daily all of which should be consumed within 6 hours.

SODIUM BIPHOSPHATE-SODIUM PHOSPHATE:

Indications: Rectal use in constipation. Bowel evacuation before abdominal radiology procedure, endoscopy and surgery.

Contraindications: acute gastrointestinal condition also to be used with caution in elderly.

Dose and Administration: adults and children above 12 years 118ml. Children

3-12 years on doctor’s advise only. Children under 3 years not recommended.

• Fecal Softeners:

CASTOR OIL:

Indications: Constipation

Dose and Administration: 10-30ml at night. Should not be taken immediately

before going to bed.