All About Laxatives

It used to be a subject reserved solely for the most private conversations, but laxatives are enjoying a moment in the sun, with football icon and TV personality Michael Strahan appearing in ads for Metamucil and MiraLAX commercials promising you can “love your laxative.” And that’s a good thing–not all laxatives are created equal, and it’s important to know the facts before heading to the pharmacy.

There’s no strict medical definition for constipation. Every person’s version of regularity is different; some people have multiple bowel movements daily, while others go only a few times a week. Generally, however, if you’re having fewer than three bowel movements a week, you are probably constipated. And producing a bowel movement is only part of the picture: If you’re straining or have hard stools, talk to your provider.

The following factors can contribute to constipation:

• A lack of fiber/fluids
• Poor diet
• Sedentariness
• Stress
• Travel
• Pregnancy

Additionally, certain medications can cause constipation.

Laxatives contain chemicals that help to either induce bowel movements or loosen the stool by increasing motility, bulk, and frequency. While there are many different kinds of laxatives on the market, it’s important to know that they’re all temporary solutions and aren’t meant as long-term fixes. Misuse or overuse can even lead to problems, including chronic constipation.

Aside from the risks associated with improper use, laxatives are generally considered safe in healthy people when used at recommended doses. One study in the American Journal of Gastroenterology found that stimulants did not harm the colon when used correctly, and there was no evidence for laxative dependency or rebound constipation.

It’s important to note that oral laxatives can interfere with the absorption of medications and nutrients, and although it’s rare, some have been shown to lead to electrolyte imbalances, which can cause abnormal heart rhythms, weakness, confusion, and seizures.

Some people are naturally more prone to constipation than others. It can be caused by many common medications and medical problems, such as hypothyroidism. If the constipation is caused by a serious condition, such as appendicitis or a bowel obstruction, laxatives can decrease the colon’s ability to contract after prolonged use, and actually worsen the constipation. So be sure to discuss laxative use with your provider and follow the dosing instructions carefully. Although laxatives are generally considered safe for breastfeeding mothers, certain ingredients can pass into breast milk, so it’s best to consult with your provider before use.

These simple lifestyle tweaks can help improve regularity:

• Drink more water. While you may not need eight glasses of water a day, staying hydrated will help you stay regular.
• Exercise regularly. The National Institute of Health and American College of Sports Medicine recommend about 30 minutes of moderate-intensity physical activity most days of the week for most adults.
• Eat more fiber-rich foods. The American Dietetic Association recommends 25 grams of fiber per day for women and 38 grams for men, but most people only get about 15. It’s not hard to add more fiber to your diet: an apple has about 4.5 grams, half an avocado has almost 7, and a cup of chickpeas has 16.
• Try yogurt. Some research indicates that the live bacteria found in some yogurt may shorten transit time through the intestine and help prevent constipation.
• Snack on prunes. In addition to being high in fiber, prunes (and prune juice) contain naturally high amounts of sorbitol and other substances that promote regularity.

If lifestyle tweaks aren’t successful,  there are several types of laxatives to consider. Before trying any kind of laxative, be sure to discuss the pros and cons with your provider.

• Bulk-forming laxatives like Metamucil, Fibercon, and Citrucel contain psyllium or other fiber and are considered gentlest. This type of laxative is typically recommended by providers if dietary and lifestyle changes haven’t been effective.
  • Side effects: Bloating, gas, cramping, or increased constipation if not taken with enough water. Increasing your fiber intake slowly may lessen the likelihood of developing side effects.

• Lubricating laxatives like mineral oil and glycerin oil make stools oily and easier to pass.
  • Side effects: Over time, lubricating laxatives can absorb fat-soluble vitamins in the intestine and decrease absorption of certain medications. They should not be taken at the same time as other medicines or supplements.

• Osmotic laxatives like milk of magnesia and Miralax contain magnesium salts or sodium biphosphate and are fast-acting. They absorb water to form soft, bulky stool and initiate normal contraction of the intestinal muscles.
  • Side effects: Bloating, cramping, diarrhea, nausea, gas, and increased thirst.

• Stool softeners/emollient laxatives like Colace and Surfak add moisture to the stool to prevent straining.
  • Side effects: Stomach pain, diarrhea, cramping, or throat irritation from oral liquid.

• Oral stimulant laxatives like Ex-Lax can irritate the lining of the colon to produce contractions. They may also contain herbal ingredients, and generally act quickly.
  • Side effects: Cramping, diarrhea, nausea, belching, urine discoloration.

• Rectal stimulants like Pedia-Lax and Dulcolax work by triggering rhythmic contractions of the intestinal muscles.
  • Side effects: Rectal irritation, stomach pain, cramping.