Constipation is a common diagnosis that requires proper evaluation and appropriate treatment. The approach to a patient with chronic constipation includes patient education, behavior modification, dietary changes, and laxative therapy.
Classification of Laxatives
In general, laxatives can be classified into four main categories: bulk laxatives, stimulant laxatives, osmotic laxatives and stool softeners.
(1) Bulk laxatives relieve constipation by forming soft and bulky stool; and by promoting contraction of intestinal muscles. They are generally considered the safest and are appropriate for patients with small hard stools. Nevertheless, they do not work until after a few days of consumption and patients need to take plenty of fluids.
Examples of bulk laxatives include methylcellulose, wheat bran, ispaghula, psyllium and sterculia.
(2) Stimulant laxatives speed up the bowel movement by stimulating the contraction of intestinal muscles. Examples of stimulant laxatives are bisacodyl, senna, glycerol and sodium picosulfate. They have a more rapid onset of action (about 6 to 12 hours) than bulk laxatives, and are usually given at night to help produce a bowel movement the following morning. Glycerol suppositories are normally used when a bowel movement is needed quickly, with onset of action of about 15 to 30 minutes.
(3) Osmotic laxatives draw fluid into the bowel, and facilitate bowel movement with bulky and softer stools.
Examples include macrogols, saline laxatives such as magnesium hydroxide, and poorly absorbed sugars such as lactulose or sorbitol.
(4) Stool softeners add moisture to stools, and make them softer and easier to pass out of the body. They have added value for patients with haemorrhoids or anal fissures, or for those who is vulnerable in stool straining, is potentially hazardous such as the elderly or those with existing cardiovascular disease. Docusate is one of the examples.
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