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Laxatives

Laxatives are foods or medicines that encourage bowel movement. Laxatives can be used to treat constipation or clear your bowels before a medical procedure.

Your GP or pharmacist may advise you to take laxatives if you have constipation. Constipation is when you have trouble opening your bowels. It’s a common problem, but can mean different things to different people, because bowel habits differ from person to person. However, health professionals define constipation in the following ways.

  • You open your bowels less than three times a week.
  • You need to strain to open your bowels on more than one in four occasions.
  • You pass hard or pellet-like stools on more than one in four occasions.

You may also be advised to take laxatives if you have a condition that could get worse if you strain during bowel movements, for example:

  • angina
  • piles (haemorrhoids)
  • a painful tear in the skin around your anus (anal fissure)

Laxatives are also prescribed to clear your bowels before surgery. Or if you’re having a test to look inside your large bowel, such as a barium enema or colonoscopy.

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Details

  • Types What are the main types of laxative?

    There are several types of laxative – some of which you can buy without a prescription. The main types are:

    • bulk-forming laxatives (also known as fibre supplements), such as wheat or oat bran, ispaghula husk, methylcellulose and sterculia
    • osmotic laxatives, such as lactulose, macrogols, sodium citrate enema and phosphate enema
    • stimulant laxatives, such as senna, and glycerol or bisacodyl suppositories
    • faecal softener laxatives, such as arachis oil and docusate sodium
  • How they work How do laxatives work?

    Each type of laxative works in a different way to help relieve or prevent constipation.

    • Bulk-forming laxatives work by increasing the amount of fibre you have in your diet so you produce more faeces. This then encourages your bowels to move and push the faeces out.
    • Osmotic laxatives work by increasing the amount of water that stays in your faeces, which makes them easier to pass.
    • Stimulant laxatives work by stimulating nerves in your bowel so that your intestine moves and pushes the faeces out.
    • Faecal softener laxatives work by lubricating and softening your faeces, which makes them easier to pass.
  • Taking the medicine How to take laxatives

    Laxatives are available as:

    • tablets, syrups or capsules you swallow
    • powders or granules that you mix in water
    • suppositories (capsules you put inside your back passage)

    Sometimes, a laxative is given as an enema (liquid injected through a thin tube into your back passage). Enemas and suppositories work within minutes to clear your bowel.

    Choosing the right type of laxative

    Bulk-forming laxatives

    Bulk-forming laxatives are usually recommended as the first type to try, especially if you find it difficult to get more natural fibre in your diet. Your doctor may also prescribe a bulk-forming laxative if you have a colostomy or ileostomy bag, irritable bowel syndrome, piles (haemorrhoids) or an anal fissure.

    Bulk-forming laxatives usually come as powders or granules that you mix in water. It's important to drink enough fluids so that the extra bulk doesn’t build up in your bowel and cause a blockage. Bulk-forming laxatives may take two to three days to start working.

    Osmotic laxatives

    If a bulk-forming laxative doesn’t work or isn’t tolerated you may need an osmotic laxative. This too may take two to three days to start working. You must drink enough fluids while taking osmotic laxatives to avoid getting dehydrated.

    Stimulant laxatives

    Stimulant laxatives should only be used if other types of laxatives haven’t worked. They come as tablets, liquids, suppositories and enemas. Tablets and liquids work within six to 12 hours, so you should take them at night for an effect the next morning.

    Faecal softener laxatives

    Faecal softeners come as medicines taken by mouth, as well as suppositories or enemas. The enemas usually work faster.

    Laxative treatment

    Laxatives are usually only recommended for short-term use if changes to your diet, such as increasing your fibre and fluid intake, haven't worked. Taking laxatives over a long time can be harmful. It’s generally recommended that you stop taking laxatives once your bowel movements have returned to normal.

    Sometimes you may need to take laxatives for weeks or months, especially if you have chronic constipation. However, you shouldn’t take laxatives for longer than a week unless your doctor advises you to. Also, you shouldn't give laxatives to children unless your doctor has prescribed them.

    Always read the patient information leaflet that comes with your medicine, and if you have any questions, ask your pharmacist or doctor for advice.

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  • Special care Special care

    Check with your GP or pharmacist before taking a laxative if:

    • you’re pregnant or breastfeeding
    • you know that your kidneys or liver aren't working properly
    • you have an inflammatory bowel disease such as ulcerative colitis
  • Side-effects Side-effects of laxatives

    This section doesn't include every possible side-effect of laxatives. Please read the patient information leaflet that comes with your medicine for more information. However, some common side-effects are listed below.

    • Bulk-forming laxatives can cause bloating, wind, stomach pains and cramps. Rarely, they can block your bowel.
    • Osmotic laxatives can cause bloating, wind, nausea and stomach cramps. You may also become dehydrated and get a headache.
    • Stimulant laxatives can cause stomach pains and cramping, and diarrhoea.
    • Suppositories and enemas can cause abdominal pain and irritate the skin around your anus.
  • Interactions Interaction of laxatives with other medicines

    Check with your GP or pharmacist before you take any other medicines or herbal remedies at the same time as a laxative.

  • Common names Names of common laxatives

    The main types of laxatives are shown in the table below.

    All medicines have a generic name. Many medicines also have one or more brand names. Generic names are usually written in lower case, whereas brand names start with a capital letter.

    There are many different products marketed for constipation. Some have more than one ingredient, or different ingredients sold under the same brand name. Ask your pharmacist for advice.

    Generic names Examples of common brand names
    Bulk-forming laxatives  
    bran  
    ispaghula husk Fibrelief, Fybogel, Isogel, Ispagel Orange, Regulan
    methylcellulose Celevac
    sterculia Normacol, Normacol Plus
    Osmotic laxatives  
    lactulose Duphalac, Lactugal, Laevolac
    macrogols Movicol, Movical-Half, Movicol-Paediatric
    magnesium salts Phillips Milk of Magnesia, Epsom Salts, Original Andrews Salts
    phosphates Fleet enema, Fletchers' Phosphate Enema
    sodium citrate Microlette, Micralax, Relaxit
    Stimulant laxatives  
    bisacodyl Dulcolax
    co-danthramer Codalax
    co-danthrusate (with docusate sodium) Normax
    docusate sodium Dioctyl, Docusol, Norgalax Micro-enema (enema)
    glycerol Glycerin suppositories
    senna Manevac, Senokot
    sodium picosulfate Dulcolax Pico Liquid, Dulcolax Pico Perles
    Faecal softener laxatives  
    arachis oil Arachis oil enema
    liquid paraffin Liquid paraffin oral emulsion

     

  • FAQs FAQs

    Can I take laxatives to lose weight?

    Answer

    No, you shouldn't do this. It doesn't work and it can be dangerous. Taking laxatives occasionally won't be harmful but they shouldn't be taken regularly. The best way to lose weight is by eating a healthy diet and exercising regularly.

    Explanation

    Laxatives can't help you lose weight. They don't stop you absorbing the food you have eaten. Laxatives work on the large bowel and most of the calories in your food are absorbed before the food reaches your large bowel. If you do notice that you have lost weight, it will be short-term and caused by a loss of water or faecal mass rather than fat.

    When you take laxatives, they help you have a bowel movement. But, at the same time, you lose water, minerals, electrolytes and indigestible fibre that help maintain a healthy body. This is safe when laxatives are only taken occasionally, but frequent long-term laxative use can cause serious health problems.

    Laxatives can cause dehydration, which can make you feel weak, faint and cause blurry vision. Disrupting the electrolyte and mineral balance in your body by taking laxatives regularly can cause muscle aches and pains, and make your heart race (palpitations).

    The best way to lose weight is by eating a healthy diet and exercising.

    I’m constipated. How long should I wait before I try taking laxatives?

    Answer

    If you’ve tried increasing your fibre and fluid intake, but are still finding it difficult or painful to have a bowel movement, consider taking laxatives.

    Explanation

    How often you have a bowel movement is specific to you. Most people have a bowel movement at least three times a week. If you haven't had a bowel movement as frequently as is normal for you, or you’re having to strain, then you may be constipated.

    Increasing your dietary fibre and fluid intake, as well as exercising regularly, can help ease constipation. If you find it difficult to add natural fibre to your diet, your doctor or pharmacist may advise you to try a bulk-forming laxative.

    Ask your pharmacist or GP for advice.

    Is it OK to increase the amount of fibre in my diet at the same time as taking laxatives?

    Answer

    If you don't think you're getting enough fibre, you should try to gradually increase the amount in your diet before you start taking laxatives.

    Explanation

    Before trying a laxative, you should increase the amount of fibre in your diet. For example, you can add bran to your food or eat a diet that’s rich in fibre. Sources of fibre include fruit, vegetables, beans and pulses. Increase dietary fibre gradually as it can cause bloating and wind.

    You should also make sure you’re drinking enough water and exercising regularly. You should aim to do at least 150 minutes (two and a half hours) of moderate physical activity during the week.

    There are different types of laxative available if lifestyle changes don't help. Certain types of laxative may be more effective than others for you, depending on what’s causing your constipation. Ask your pharmacist or GP for advice and explain your symptoms to them.

  • Resources Resources

    Further information

    Sources

    • Ford AC, Talley NJ. Laxatives for chronic constipation in adults. BMJ 2012; 345:e6168 doi:10.1136/bmj.e6168
    • Constipation. British Society of Gastroenterology. www.bsg.org.uk, accessed 28 February 2014
    • Management of constipation in older adults. Best Practice Factsheet. Joanna Briggs Institute 2008; 12(7)
    • Joint Formulary Committee. British National Formulary (online) London: BMJ group and Pharmaceutical Press. www.medicinescomplete.com, accessed 26 November 2013 (online version)
    • Constipation. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised January 2013
    • Poloxamer – brand names. Drug Information Online. www.drugs.com , accessed 27 November 2013
    • Haemorrhoids – preferred products. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised September 2012
    • Phillips Milk of Magnesia. electronic Medicines Compendium. www.medicines.org.uk, revised 8 July 2013
    • Original Andrews Salts. electronic Medicines Compendium. www.medicines.org.uk, revised October 2006
    • Fletchers' Phosphate Enema. Drug Information Online. www.drugs.com, revised July 2010
    • Laxative abuse: some basic facts. National Eating Disorders Association (NEDA). www.nationaleatingdisorders.org, accessed 28 November 2013
    • Hypokalemia. Medscape. www.emedicine.medscape.com, published 25 April 2012
    • Maintaining a healthy weight. British Heart Foundation. www.bhf.org.uk, accessed 28 November 2013
    • Physical activity and adults. World Health Organization. www.who.int, accessed 28 November 2013
  • Related information Related information

  • Author information Author information

    Reviewed by Alice Rossiter, Bupa Health Information Team, February 2014

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