purgative adj : strongly laxative [syn: cathartic, evacuant] n : a purging medicine; stimulates evacuation of the bowels [syn: cathartic, physic, aperient]
- Greek: καθαρτικό
Laxatives (or purgatives) are foods, compounds, or drugs taken to induce bowel movements or to loosen the stool, most often taken to treat constipation. Certain stimulant, lubricant, and saline laxatives are used to evacuate the colon for rectal and bowel examinations, and may be supplemented by enemas in that circumstance. Sufficiently high doses of laxatives will cause diarrhea. Laxatives only work to hasten the elimination of undigested remains of food in the large intestine and colon.
There are several types of laxatives, listed below. Some laxatives combine more than one type of active ingredient to produce a combination of the effects mentioned. Laxatives may be oral or in suppository form.
Constipation with no known organic cause, i.e. no medical explanation, exhibits gender differences in prevalence: females are more often affected than males. Not surprisingly, some advertisers promote their brands as being more feminine and thereby tailor their message to the market. The way laxatives function in males and females, however, does not exhibit significant differences.
Vegetables and foodsSome vegetables and foods can be eaten to cure constipation and act as laxatives, although the effectiveness may vary. These include:
- Aloe Vera
- Apple Juice
- Chicken Broth
- Dried apricots
- Hot Tea w/ Lemon
- Prunes/Prune Juice
- Spicy Foods
Also known as bulking agents or roughage, these include dietary fiber. Bulk-producing agents cause the stool to be bulkier and to retain more water, as well as forming an emollient gel, making it easier for peristaltic action to move it along. They should be taken with plenty of water. Bulk-producing agents have the gentlest of effects among laxatives and can be taken just for maintaining regular bowel movements.
Stool softeners / Surfactants
- Site of Action: Small and large intestine
- Onset of Action: 12 - 72 hours
- Examples: docusate (Colace, Diocto)
Lubricants / Emollient
- Site of Action: Colon
- Onset of Action: 6 - 8 hours
Hydrating agents (osmotics)These cause the intestines to hold more water within, softening the stool. There are two principal types, saline and hyperosmotic.
Saline laxatives attract and retain water in the intestinal lumen, increasing intraluminal pressure and thus softening the stool. They will also cause the release of cholecystokinin, which stimulates the digestion of fat and protein. Saline laxatives may alter a patient's fluid and electrolyte balance.
Sulfate salts are considered the most potent.
Lactulose works by the osmotic effect, which retains water in the colon, lowering the pH and increasing colonic peristalsis. Lactulose is also indicated in Portal-systemic encephalopathy. Glycerin suppositories work mostly by hyperosmotic action, but also the sodium stearate in the preparation causes local irritation to the colon.
Solutions of polyethylene glycol and electrolytes (sodium chloride, sodium bicarbonate, potassium chloride, and sometimes sodium sulfate) are used for whole bowel irrigation, a process designed to prepare the bowel for surgery or colonoscopy and to treat certain types of poisoning. Brand names for these solutions include GoLytely, GlycoLax, CoLyte, NuLytely, and others.
EffectivenessFor adults, a randomized controlled trial found PEG [MiraLax or GlycoLax] 17 grams once per day better than tegaserod 6 mg twice per day. A randomized controlled trial found greater improvement from 2 sachets (26 grams) of PEG versus or 2 sachets (20 grams) of lactulose . 17 grams/day of PEG has been effective and safe in a randomized controlled trial for six months. Another randomized controlled trial found no difference between sorbitol and lactulose .
Stimulant / Irritant
- Site of Action: Colon
These stimulate peristaltic action and can be dangerous under certain circumstances. Long term use can lead to 'cathartic colon'. Stimulant laxatives act on the intestinal mucosa, or nerve plexus; they also alter water and electrolyte secretion. They are the most severe among laxatives and should be used only in extreme conditions. Castor oil may be preferred when more complete evacuation is required.
- Site of Action: Small intestine
Serotonin agonistTegaserod is a motility stimulant that works through activation of 5-HT4 receptors of the enteric nervous system in the gastrointestinal tract. However caution must be taken due to potentially harmful cardiovascular side-effects.
UsesBowel Prep. Chronic constipation. Chronic immobility.
Problems with use
Laxative AbuseLaxative abuse is potentially serious since it can lead to intestinal paralysis, Irritable Bowel Syndrome (IBS), pancreatitis, renal failure, and other problems.
Laxative gutPhysicians generally warn against the chronic use of stimulant laxatives due to concern that chronic use causes the colonic tissues to get worn out over time and not be able to expel feces due to long term overstimulation. The evidence for this was never too strong, and it was always unclear whether the elongated and poorly moving colon of a patient with chronic constipation was a result of or was just a cause for patients' use of stimulant laxatives. A common finding in patients who have used stimulant laxatives is a brown pigment deposited in the intestinal tissue, known as Melanosis coli.
Eating DisordersLaxatives are often used by people with an eating disorder. In many cases of bulimia nervosa the patient will abuse laxatives in an attempt to purge themselves of food in the intestines before it becomes digested. Frequently, patients with eating disorders had chronic digestive problems in childhood and found laxatives an effective treatment. The laxative use later may substitute of more appropriate treatment such as a better diet. Treatment of patients with eating disorders and gastrointestinal illnesses can be challenging.
purgative in Czech: Laxativum
purgative in German: Abführmittel
purgative in Spanish: Laxante
purgative in French: Laxatif
purgative in Croatian: Laksativi
purgative in Indonesian: Laksatif
purgative in Dutch: Laxeermiddel
purgative in Japanese: 瀉下薬
purgative in Norwegian: Avføringsmiddel
purgative in Polish: Środki przeczyszczające
purgative in Portuguese: Laxante
purgative in Russian: Слабительное
purgative in Simple English: Laxative
purgative in Slovak: Preháňadlo
purgative in Finnish: Laksatiivi
purgative in Swedish: Laxermedel
purgative in Thai: ยาระบาย
purgative in Chinese: 泻药
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