Cornell
Health
Laxative Use
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Laxaves are medicines that treat conspaon,
either by soening the stools or by smulang the
intesnes to push out stool/have a bowel movement.
While they can be safely used temporarily, they
can do more harm than good if used improperly or
chronically without medical guidance.
Types of laxatives
Smulant laxaves such as bisacodyl
(Dulcolax), castor oil, and senna (Senokot),
are non-prescripon "over-the-counter” (OTC)
medicaons. They smulate the nerves in the
walls of the large intesnes and cause intesnal
contracons as well as uid and electrolyte
changes. While easily accessible, they can be
dangerous if used improperly, and are the most
commonly abused laxaves. These laxaves
can be habit forming, meaning that increasingly
higher doses are needed to obtain the same
eects.
“Natural” smulant laxaves usually contain
senna. These are smulant laxaves (see above)
that happen to come from plant sources. Their
dangers are the same as those of synthec
smulant laxaves.
Non-smulant laxaves are safer if used correctly
and in appropriate doses. They include the following:
• Osmoc laxaves such as Miralax and Milk
of Magnesia work by drawing uid into the
intesnes. These are less habit-forming;
however, they can sll cause uid and
electrolyte imbalances when used incorrectly.
Some require a prescripon.
• Lubricant and emollient laxaves, such as
mineral oil or docusate (Colace), work by
soening the stool. These are generally safe to
use for a limited me.
• Bulk-forming laxaves, such as psyllium
(Metamucil), Citracel, and FiberCon, are
generally safe and also are a source of dietary
ber. When used in higher-than-recommended
doses, bulk-forming laxaves can cause
intesnal problems and block absorpon of
other nutrients.
Laxative misuse
Some people take large quanes of laxaves at one
me. Others take laxaves at their recommended
dose, but on a fairly regular basis. Most people
should rarely, if ever, require a smulant laxave,
and laxaves should never be used in higher-than-
directed doses or over long periods of me. Once
a paern has started, however, people oen nd it
very dicult to stop taking laxaves because they
become reliant on them.
Laxaves can be safely used temporarily, but can do
more harm than good if used improperly.
Impacts of laxative misuse
Conspaon and impaired intesnal funcon:
With laxave misuse, the intesnes lose muscle
and nerve response. The intesnes then become
dilated and ineecve in moving stool out on its
own. This is oen reversible, but recovery may be
a slow process.
Alternang conspaon, diarrhea, and gas:
Laxave use can result in rebound conspaon,
which may include trapped gas in the intesnes.
This can cause people to try to treat those
symptoms with more laxaves, resulng in
diarrhea and a connued cycle of laxave use.
Dehydraon: Laxave over-use can cause
diarrhea, which can result in uid loss and
dehydraon. Common symptoms include thirst,
decreased urinaon, headache, light-headedness,
diminished sweang, dry mouth, and weakness.
Electrolyte abnormalies: Electrolytes such
as sodium, potassium, and chloride are lost at
abnormally high rates when someone experiences
diarrhea. Although severe complicaons are
infrequent, they are unpredictable and can
happen to someone who misuses laxaves for
the rst me, or to someone who has misused
laxaves for years.
Blood in stool and anemia: Irritaon of the colon
can lead to blood in the stools, which in turn can
cause anemia (low iron).
Rectal prolapse: Chronic severe diarrhea caused
by laxave misuse can cause the inside of the
intesnes to protrude through the anal opening.
This condion usually requires surgical treatment.
(Over)