Laxative

TREATMENT OF
CONSTIPATION
CONSTIPATION
 Difficult, incomplete, or infrequent
evacuation of dry hardened feces from the
bowels
 It is symptom, not a disease
 Disorder of movement through the colon

and/or rectum
 Can be caused by a variety of diseases or

drugs
 The terms laxatives, cathartics, purgatives, and evacuants
often are used inter changeably.
 There is a distinction, however, between laxation (the

evacuation of formed fecal material from the rectum) and
catharsis (the evacuation of unformed, usually watery fecal
material from the entire colon).
 Laxatives are employed before surgical, radiological, and

endoscopic procedures where an empty colon is desirable.
Don’t use laxatives
MANAGEMENT OF CONSTIPATION
 adherence to a fiber-rich (20–30 g daily)
diet,
 adequate fluid intake
 appropriate bowel habits and training
 avoidance of constipating drugs
Exaluminium containing antacids & Iron
MANAGEMENT OF CONSTIPATION
 adherence to a fiber-rich (20–30 g daily)
diet,
 adequate fluid intake
 appropriate bowel habits and training
 avoidance of constipating drugs
Exaluminium containing antacids & Iron
 Constipation related to medications can be corrected by
use of alternative drugs where possible, or adjustment
of dosage.
 If nonpharmacological measures alone are inadequate,

they may be supplemented with bulk-forming agents or
osmotic laxatives.
LAXATIVES
Chronic use of laxatives may make you…

dependent
LAXATIVES
1. Bulk laxatives:
Wheat Bran, Carboxy methylcellulose,
Psyllium husk & Ispaghula husk.
2. Osmotic laxative:
Saline purgatives:MgSo4 (Epsom salts), Mg(OH)2 (MOM),
Polyethylene glycol (PEG) & Lactulose
3. Fecal Softners:
DOSS (dioctyl sodium sulfosuccinate), Mineral oils,
Glycerin & Liquid paraffin
4. Stimulant/Irritant Purgative/laxative:
Senna, Cascara, Castor oil, Bisacodyl & Phenolphthalein
LAXATIVES
 1)Bulk laxatives: by increasing the volume of non-

absorbable solid residues
 Eg:Hydrophilic Colloids, Bran, Methylcellulose, Psyllium,

Ispaghula
 2)Osmotic laxative: by increasing the water content
 Eg:
Saline purgatives:MgSo4 (Epsom salts), Mg(OH)2 (MOM),
Lactulose
 3)Fecal Softners: by altering the consistency of
feces
 Eg:
DOSS (dioctyl sodium sulfosuccinate), Mineral oils,
Glycerin suppositories
 4)Stimulant/Irritant Purgative/laxative: by
increasing the motility and secretion
 Eg: Senna, Cascara, Castor oil, Bisacodyl. Phenolphthalein

BULK LAXATIVES
 MOA –
Luminally active, hydrophilic, indigestible fibres.
absorb water & retain
Increase faecal bulk
Stimulate peristalsis & defaecation reflexes
 Are first line approach for most pts of simple constipation

BULK LAXATIVES
 Adequate water must be taken with all bulk forming laxatives
 Effects appear within 1 to 3 days
 ADRs:
Quite safe
Bloating & flatus – Abd discomfort
OSMOTIC LAXATIVES
Saline purgatives:
 Laxatives containing magnesium cations or phosphate anions
commonly are called saline laxatives:
 Ex:magnesium sulfate, magnesium hydroxide,
magnesium citrate, & sodium phosphate
 MOA :
Soluable inorganic salts not absorbed in intestine
retain more water osmotically
distend the bowel
increase peristalsis
leads purgation about an hour later
OSMOTIC LAXATIVES
Saline purgatives:
 MOM is tasteless, others have unpleasant taste
 Morning
 Effects within 2-3 hrs
 Sufficient water intake
 ADRs
Irritants – vomitting
electrolyte disturbance
 C/I
 CHF, HTN
 Renal insufficiency – Mg salts Hypermagnesaemia
OSMOTIC LAXATIVES
Polyethylene glycol (PEG)

 Electrolyte osmotic purgative
 MOA :
Sugar
retain more water osmotically
distend the bowel
increase peristalsis
leads purgation about an hour later
OSMOTIC LAXATIVES
Polyethylene glycol (PEG)

 Orally 4 L over 2-3 hrs – Complete colonic cleaning
 Orally 300 – 500ml morning – chronic constipation
 Sufficient water intake
 ADRs
 Used
For preparation of bowel before surgery and colonoscopy
LACTULOSE
 Semisynthetic disaccharide of fructose and galactose

 MOA :
Luminally active non absorble indegstible sugar
water absorption
increase faecal bulk
 10 g BD with plenty of water
 1-2 days to act
 ADRs
Flatulence, Abd cramps
LACTULOSE
 In colonbacteria convert it into lactic acid
 gut contents have low pH than normaldecrease activity of

ammonia producing organismhence used in treatment of
hepatic encephalopathy
OSMOTIC LAXATIVES
Glycerin
 Used as rectal suppositories
 ADRs
electrolyte disturbance
 Uses
acute congestive glaucome
cerebral edema
sweetening agent
dressing of wounds, ulcer
emollient
FECAL SOFTENERS
 Promote more water and fat in the stools
 Lubricate the fecal material and intestinal walls
 Uses: condition where straining at stool has to be

avoided like hernia, piles, fissures, anal surgery
FECAL SOFTENERS
Liquid paraffin
 Pharmacologically inert mineral oil
 MOA
Luminally active – retards water absorption from stool

stool softener
 15-30 ml per day at bed time
 1-3 days
 ADRs
 Fat soluble vitamin deficiency
 Lipoid aspiration pneumonia
FECAL SOFTENERS
DOSS
 MOA
Luminally active – retards water absorption from stool by

reducing surface tension of fluid in bowel
stool softener
 100 – 400mg per day at bed time
 1-3 days
 ADRs
 Nausea
 Cramps & Abd cramps
STIMULANT LAXATIVE
 Used mainly for preparation of bowel for
surgery, colonoscopy and abd X-rays
 MOA
 They increase the peristalsis by stimulation
of gut mucosa
 Organic irritants mainly act on colon
 Castor oil is non irritant. But converted in
intestine by pancreatic lipase to ricinolic
acid – increase intestinal motility
STIMULANT LAXATIVE
Dose
 Senna – 12-25mg at bed time Effects – 6-8 hrs
 Bisacodyl- 5-10mg at bed time 8-10 hrs
suppository avai
 Sodium picosulfate – 5-10mg at bed time 6-8
hrs
 Castor oil – 15- 25ml morning 3hrs
STIMULANT LAXATIVE
ADRs
 Senna
yellowish brown/red colour urine

Abd cramps & nausea
C/I pregnancy & lactating mother
 Bisacodyl
safe, occasional cramps & skin rashes

 Sodium picosulfate – prolong use - Hypokalemia
 Castor oil – Unpalatability, freq. cramps,
damage to intestinal mucosa
STIMULANT LAXATIVE
 They increase the peristalsis by stimulation
of gut mucosa
 Causes abd cramps, prolonged use cause

atonic colon(sluggish bowel)
Food or drug poisoning Saline
Following antihelmintic Rx Saline
Before surgery / radiological stimulant
exam of abd
Drug induced constipation
Straining to be avoided Lubricant
Hepatic encalopathy lactulose
ABSOLUTE C/I
 Undiagnosed acute abdomin
 Intestinal obstruction
 Inflammatory bowel disease
intestinal perforation & peritonitis

EVACUTANT ENEMA
 Fecal impaction
 Before radiological examination or surgery
 Soap water, mineral oil, glycerin, DOSS,

bisacodyl

Laxative

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TREATMENT OF

 It is symptom, not a disease

 Disorder of movement through the colon

 Can be caused by a variety of diseases or

 There is a distinction, however, between laxation (the

 Laxatives are employed before surgical, radiological, and

 If nonpharmacological measures alone are inadequate,

Chronic use of laxatives may make you…

 1)Bulk laxatives: by increasing the volume of non-

 Eg:Hydrophilic Colloids, Bran, Methylcellulose, Psyllium,

 2)Osmotic laxative: by increasing the water content

 Eg: Senna, Cascara, Castor oil, Bisacodyl. Phenolphthalein

 Are first line approach for most pts of simple constipation

 Adequate water must be taken with all bulk forming laxatives

 Effects appear within 1 to 3 days

Polyethylene glycol (PEG)

Polyethylene glycol (PEG)

 Semisynthetic disaccharide of fructose and galactose

 In colonbacteria convert it into lactic acid

 gut contents have low pH than normaldecrease activity of

 Promote more water and fat in the stools

 Lubricate the fecal material and intestinal walls

 Uses: condition where straining at stool has to be

Luminally active – retards water absorption from stool

Luminally active – retards water absorption from stool by

yellowish brown/red colour urine

safe, occasional cramps & skin rashes

 Causes abd cramps, prolonged use cause

intestinal perforation & peritonitis

 Soap water, mineral oil, glycerin, DOSS,

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