General Guidelines

An important point to be remembered is that many patients with normal stools and normal frequency of defecation imagine that they are constipated. They need reassurance and no drug treatment. Patients with acute (suddenly developed) constipation should consult the doctor for the diagnosis of the underlying cause.

Patients with chronic constipation need bowel training. They must spare some time regularly every morning to visit the toilet. They should also drink plenty of water, eat leafy vegetables and fiber food with high fiber content. Besides this, they should also take physical exercise, such as walk for half to an hour daily. Laxatives such as senna and isphagulla can be used for short periods and then slowly stopped (suddenly stopping use of a laxative may cause recurrence of constipation).

When should a laxative be used?

A laxative should be used for short periods only as its long-term use is harmful.

It is mainly used:

	a)	in elderly bed-ridden patients suffering from constipation due to lack of exercise.
	b)	to clear the bowel and investigative procedures, e.g., colonoscopy.
	c)	to prevent pain and straining (i) in people with hernia (ii) in people with piles (iii) after childbirth
		and (iv) after abdominal surgery.

Types of laxatives

	1.	Bulk forming laxatives: They absorb water in the bowel thereby increasing the volume of faecal
		matter and making stools softer and easier to pass. They are slow acting and less likely to
		interfere with normal bowel action as compared to other laxatives they may cause intestinal
		obstruction and hence should be taken after doctor's consultation by people suffering from
		constipation with abdominal pain, e.g., Isphagulla (isabgol), methylcellulose.
	2.	Stimulant (contact) laxatives: They cause the bowel muscle to contract, increasing the speed
		with which faecal matter passes through the intestine. They are fast acing and used only when
		other treatments have failed. They may cause abdominal cramps and diarrhoea and should
		normally not be used for more than a week, e.g., bisacodyl, docusate, phenolphthalein, senna.
	3.	Lubricants: It makes the bowel movements softer and easier to pass without increasing the
		bulk. It is used when hard bowel movements cause pain on defecation, e.g., piles and also in
		elderly people. Prolonged use causes coating which can interfere with absorption of certain
		essential vitamins, e.g., liquid paraffin.
	4.	Saline laxatives: They prevent water from passing out of the large intestine without increasing
		the bulk of the faeces. They are used to clear the bowel before surgery or investigative
		procedures. They are not preferred for long-term relief or constipation as they cause chemical
		imbalances in the body, e.g., Epsom salt (magnesium sulfate).
	5.	Lactulose: It causes fluid to accumulate in the intestine. It is used for long-term treatment of
		chronic constipation as an alternative to bulk forming laxatives. It may cause stomach cramps
		and flatulence (gas).

Precautions

*	Do not use a laxative frequently to treat constipation as habit may be formed.
*	Laxatives can cause diarrhoea if taken in overdose and constipation if overused.
*	Discontinue use of laxative slowly as soon as normal bowel movements are re-established.
*	Do not use laxatives to treat constipation associated with fever or following heart attack.
*	Do not use laxatives in children except special circumstances on the advice of a doctor.
Consult a doctor in the following cases:
*	A patient has constipation with vomiting, fever and has not even passed wind (gas).
*	Chronic constipation with no improvement after two weeks treatment.
*	Unexplained constipation in elderly.
*	Persistent constipation in children.
*	Persistent pain in stomach or blood in stools or pain during evacuation.

Combination Products

Many times laxatives are combined with anthelmentics (drugs that expel worms). This combination is irrational and has no benefit over single product containing only anthelmentic.