Constipation and Bowel Regimens

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• Laxative: substance that accelerates defecation
• Osmotic and stimulant
Bulk producing laxatives
• For treatment and prevention
• Psyllium (Metamucil)
• With sugar formulations are 50% sugar
• Must take with water

• Methylcellulose (Citrucel)
• Nonfermentable  less gas
Stool softeners
• Docusate (Colace)
• Surfactant laxative
• Water and fat incorporated into stools
• Long term use  less effective
Stimulant laxatives
• Senna
• Water and fat incorporated into stool  soften
• Pro-peristaltic
• Onset within 6-12 hours
• Effective only when used with other agents

• Bisacodyl (Dulcolax)
• Stimulates colonic intramural neuronal plexus
• Alters water and electrolyte secretion
• May cause abdominal cramping
• Onset within 15-60 minutes (rectal), 6-10 hours (PO)
• Not very effective unless used with other agents
Saline laxatives
• For acute treatment of constipation
• MgOH (Philips), mag citrate, MgSO4
• Osmotic retention of fluid  colonic distension  motility
• Onset within 30 minutes – 6 hours
• Stimulates CCK
• Use with caution in renal failure
Lubricant laxatives
• Decrease water absorption
• Mineral oil (fleet)
• Long term use  lipid PNA, lymphoid hyperplasia?
• Onset within 6-8 hours
Osmotic laxatives
• For long term treatment
• Lactulose
• Onset within 1-2 days

• Sorbitol
• Onset within 1-2 days

• Polyethylene glycol (miralax)

• ?lower risk of dehydration than hyperosmolar laxatives
• Onset within 1-4 days
• Most popular bowel prep for scopes
• AE: nausea, abdominal pain, emesis
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• Glycerin, onset 15-30 minutes
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