HWN Suggests

Stimulant Laxatives

Besides the ubiquitous Biscodyl (Dulcolax) there are the botanicals...

Botanical stimulant laxatives all generally contain a class of compounds referred to as anthraquinone glycosides. Once ingested and activated by bacterial metabolism in the human gut, these molecules promote water retention in the stool and stimulate peristalsis in the large intestine (colon).

Aloes

Aloes powder is the solid residue obtained by evaporating the liquid which drains from the transversely cut leaves of Cape Aloes (Aloe ferox). The juice is usually concentrated by boiling and solidifies upon cooling. It is characteristically dark-brown or greenish-brown. It has…

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Featured

 Are all stimulant laxatives the same? A comparative perspective on bisacodyl, sodium picosulfate (SPS) and senna

Stimulant laxatives, such as bisacodyl, sodium picosulfate (SPS), and senna, are recommended to treat constipation, based on the recent AGA/ACG guideline, with different levels of recommendation and evidence. They all stimulate intestinal motility, as well as water and electrolyte secretion, and accelerate intestinal transit time. Herbal laxatives cannot be generalized to be gentler compared other to synthetic laxatives.

 Stimulant Laxatives for the Treatment of Chronic Constipation: Is it Time to Change the Paradigm?

Stimulant laxatives have been present for decades, but their use has been hindered by myths and misconceptions regarding their safety and tolerability, as well as a lack of data supporting their efficacy. Despite the fact that they are regularly used by consumers, these key issues have not been historically validated.

Articles of Interest

Cochrane Review: Osmotic and stimulant laxatives for the management of childhood constipation

The pooled analyses suggest that PEG preparations may be superior to placebo, lactulose and milk of magnesia for childhood constipation. GRADE analyses indicated that the overall quality of the evidence for the primary outcome (number of stools per week) was low or very low due to sparse data, inconsistency (heterogeneity), and high risk of bias in the studies in the pooled analyses. Thus, the results of the pooled analyses should be interpreted with caution because of quality and methodological concerns, as well as clinical heterogeneity, and short follow up. However, PEG appears safe and well tolerated.

How to Use Stimulant Laxatives for Constipation

After an extensive research review, the American College of Gastroenterology recommends sodium picosulfate and bisacodyl. They decline to recommend any other types due to lack of sufficient research.

Movin’ right along

Stimulant laxatives, including anthraquinones (senna), diphenylmethanes (biscodyl), and castor oil, stimulate bowel activity and increase secretion of fluids into the bowel. The time to onset of action for senna and bisacodyl is usually 6 to 10 hours after oral administration but may take up to 24 hours. Stimulant laxatives should be used sparingly, as impaired colon function can occur with chronic use.

Stimulant laxatives (bisacodyl, senna and sennosides, sodium picosulfate) available over-the-counter: new measures to support safe use

We have introduced pack size restrictions, revised recommended ages for use, and new safety warnings for over-the-counter stimulant laxatives (orally and rectally administered) following a national safety review. Advise patients that dietary and lifestyle measures should be used first-line for relieving short-term occasional constipation and that stimulant laxatives should only be used if these measures and other laxatives are ineffective.

Resources

Dulco

When it comes to ‘Number Twos’ we are #1*

Senna

Senna is used on a short-term basis to treat constipation. It also is used to empty the bowels before surgery and certain medical procedures. Senna is in a class of medications called stimulant laxatives. It works by increasing activity of the intestines to cause a bowel movement.