Laxatives for the elderly

Constipation is not uncommon in older adults, so along with changes in diet, doctors often prescribe laxatives for older people.

Such agents cause increased intestinal peristalsis, accelerated movement of feces and easier bowel movements.

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Indications for the use of laxatives for the elderly

Laxatives in the elderly are used in the following situations:

• before surgery;
• in combination with the use of anthelmintic drugs;
• in case of poisoning;
• for constipation of various origins associated with adynamia, insufficient food and fluid intake, thyroid disease, atherosclerosis, taking certain medications, spinal disorders, etc.

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Release form

Laxatives for the elderly are available in a variety of convenient forms:

• powder for oral administration;
• oil for internal use;
• solution for oral use;
• rectal suppositories;
• tablets, capsules;
• herbal infusions for brewing.

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Pharmacodynamics of laxatives for the elderly

Laxatives may have different pharmacological mechanisms of action. However, all the possibilities of such drugs are aimed at achieving one goal - eliminating constipation and intestinal atony. How can this be achieved?

• The effect of irritation of the intestinal receptors is created, the mucous tissues are directly affected, due to which peristalsis is enhanced and the secretion of mucus into the large intestine increases (herbal preparations, bisacodyl, etc.);
• The volume of intestinal contents increases, which stimulates the intestinal walls and provokes increased peristalsis (salt preparations, seaweed);
• Softening of fecal accumulations occurs, which facilitates bowel movements (oil preparations).

Saline preparations (lactulose, macrogol, magnesium sulfate) are not adsorbed into the systemic bloodstream, creating an increase in osmotic pressure and retaining fluid inside the intestine. This promotes mechanical stretching of the intestinal walls, which gives impetus to increased peristalsis and more frequent urge to defecate.

Suppositories are designed to irritate the rectal mucosa, stimulating the urge to defecate. However, this action makes suppositories undesirable in the case of exacerbation of hemorrhoids or inflammatory processes in the anus and rectum.

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Pharmacokinetics of laxatives in the elderly

Phytopreparations with anthraglycoside composition are biotransformed in the liver, where chrysophanic acid and emodin are released. The latter are excreted through the kidneys and are also found in breast milk and sweat secretions.

Buckthorn preparations may be slightly absorbed into the bloodstream and excreted by the urinary system: in this case, the urine may change color to red or dark yellow.

Laxatives for the elderly are prescribed mainly at night, since the effect of the drugs is expected approximately 6-8 hours after their use.

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Names of laxatives for the elderly

As we have already said, laxative medications are divided depending on the mechanisms and methods of their action:

• receptor irritants of the intestinal walls (rhubarb, buckthorn, buckthorn, senna, sabura, isaphenin, phenolphthalein, castor oil, etc.);
• agents that stretch the intestinal walls (sodium and magnesium sulfates, salts, lactulose, flax, seaweed, etc.);
• agents that soften fecal matter (oily preparations, antispasmodics).

Stools close to natural quality can be expected after taking Kafiol, Vaseline oil, seaweed, sulfur, etc.

A more liquid stool is expected after taking herbal preparations (rhubarb, senna, buckthorn), castor oil, phenolphthalein, bisacodyl, oxyphenisatin, etc.

Diarrhea-like stools can be caused by salt preparations (magnesium and sodium sulfates).

Method of administration and dosage

Rhubarb rhizome – produced in tablets of 0.3 and 0.5 g, as well as in powder, used to treat chronic constipation. Take orally before going to bed from 0.5 to 1.5 g at a time, or 0.5 g three times a day before meals. The drug is not recommended for children under one year of age. From one year of age, it can be used in a dose of 0.1 to 0.5 g as prescribed by a doctor.

Buckthorn, bark - sold in 100 g packages. Take orally 100 ml in the form of a decoction (40 g of raw material per 0.4 l of water) in the morning on an empty stomach and before bed. Can be combined with other laxatives, in particular, with saline ones.

Buckthorn, liquid extract – used orally from 20 to 40 drops in the morning and evening.

Buckthorn, tablets (dry extract) – take 1-2 tablets immediately before going to bed.

Buckthorn fruits are sold in 100 g packages. They are used as a decoction of 100 ml before bedtime (one tablespoon of raw material is brewed in 200 ml of boiling water).

Senna, leaves - is available in 100 g boxes. The drug is used orally, one tablespoon of infusion three times a day (to prepare the infusion, take 10 g of leaves per 100 ml of water). The drug acts gently and effectively, so it is often used in childhood.

Kafiol is a combination medicine consisting of senna leaf and fruit, plum fruit, fig and vaseline oil. It is produced in the form of chewing briquettes. Use half or a whole briquette at a time before bedtime. If constipation is chronic and persistent, it is allowed to use kafiol twice a day. The maximum daily dose of the drug is 5 briquettes, the maximum duration of treatment is up to 2 weeks.

Knotweed is produced as dry raw material in 100 g packages. An infusion of the plant (10 g of raw material per 100 ml of water) is taken, one tablespoon three times a day for atony and intestinal spasms.

Licorice root, powder – used orally 1-2 teaspoons of powder up to 3 times a day, in childhood – a quarter or half a teaspoon.

Gastric collection – a herbal mixture consisting of buckthorn, mint, nettle, calamus and valerian. It is used for brewing (one tablespoon per 200 ml of boiling water). Drink half a glass in the morning and at night.

Glycerin suppositories – are produced in the form of suppositories for adults and children. They are used by inserting 1 suppository into the rectum per day in the morning, 20 minutes after eating. If signs of irritation appear, the drug is discontinued.

Phenolphthalein – can be produced in the form of powder or tablets (0.1 and 0.05 g). The drug is used orally from 1 to 2 tablets before bedtime (2 hours after the last meal), or 1 tablet twice a day after breakfast and dinner. The maximum permissible daily dosage is 0.3 g. Use in childhood: it is not recommended to use the drug under 3 years of age; starting from 3 years of age, use from 0.05 g to 0.15 g per day.

Isaphenin is produced in the form of powder or tablets of 0.01 g. It is used orally, one tablet twice a day after meals, or 2 tablets once before bedtime.

Isaman - take 1-2 tablets orally after meals, daily for the first three days, then every other day or once or twice a week.

Carlsbad salt – produced in 125 mg sachets. Used orally 1-2 teaspoons, previously dissolved in warm water. Take before bed or during the day on an empty stomach.

Castor oil – produced in 30 or 50 ml bottles, as well as in capsule form of 1 g. Taken orally after meals from 1 to 2 teaspoons at a time. Take 10 capsules over 1 hour.

Vaseline oil - used for oral administration from 1 to 2 tablespoons per day between meals.

Seaweed powder – used orally, half or a whole teaspoon of powder once a day after meals.

Bisacodyl is available in the form of 0.005 g dragees and 0.01 g suppositories. Use orally from 1 to 3 dragees at night, or in the morning 30 minutes before meals. In the form of rectal suppositories, use from 1 to 2 per day. In childhood, the drug is used from 1 year, prescribing one dragee or ½ or a whole suppository per day.

Lactulose (Dufalac) – used in the morning during breakfast, 15-30 ml. In childhood, 5 ml of the drug is used per day at one time.

Forlax (macrogol) – is produced in the form of sachets with powder. Use 1 sachet, having previously dissolved it in a glass of water. Use up to 4 sachets per day.

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Contraindications to the use of laxatives for the elderly

The most common contraindications to the use of laxatives for the elderly are:

• individual cases of intolerance to any components of the drug;
• suspected intestinal obstruction;
• the presence of an incarcerated hernia, as well as inflammatory processes of internal organs in the acute stage;
• gastric, intestinal and uterine bleeding;
• electrolyte metabolism disorders;
• appendicitis;
• abdominal pain of unknown origin;
• inflammation of the bladder.

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Side Effects of Laxatives for the Elderly

When prescribing laxatives to older people, special attention should be paid to the possible side effects of the proposed drugs, so carefully read the instructions before using the drug.

The most common side effects that laxatives can cause are:

• increased gas formation, diarrhea, bouts of nausea and vomiting;
• colicky abdominal pain;
• convulsions;
• fluid and electrolyte imbalances;
• allergic reactions, skin rash.

If any side effects occur, be sure to inform your doctor.

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Overdose

Sometimes, when taking high doses of laxative medications, constipation can be replaced by diarrhea, which usually does not require additional treatment measures and is completely relieved within 24 hours after stopping taking the drug.

With long-term use of laxatives, side effects may increase, as well as disruption of water-electrolyte metabolism, atonic phenomena in the large intestine, and dehydration.

Treatment in case of development of signs of overdose is symptomatic.

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Laxative Interactions in the Elderly

Laxatives should not be used simultaneously with drugs that reduce intestinal peristalsis (loperamide, imodium): such combined use can provoke intestinal obstruction.

The use of laxatives may interfere with the absorption of other medications. It is especially necessary to review the dosage of oral hypoglycemic agents, antiepileptic drugs and antibiotics.

Use with caution when taking drugs that provoke electrolytic metabolism disorders and blood acidosis (calcium channel blockers, lithium preparations, diuretics).

With the combined use of laxatives and antihypertensive drugs, a decrease in the concentration of potassium in the blood serum may be observed.

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Storage conditions for laxatives for the elderly

Laxative tablets can be stored at t°C– 7-25°C. Shelf life – up to 3 years.

Candles and suppositories should only be stored in the refrigerator.

Oils and solutions must be protected from direct sunlight.

Children should not be allowed into areas where medicines are stored.

Do not use medicines after the expiration date.

Means that regulate and stimulate bowel movements can be purchased in pharmacies without a prescription from a doctor. But it is necessary to take into account that the abuse of such drugs can harm the patient's health. For this reason, do not ignore the advice of a specialist and carefully read the annotation to the medications.

The use of laxatives in old age may be less effective due to age-related changes and existing diseases. This is especially true for patients who have been on bed rest for a long time. In such situations, laxatives for the elderly must be combined with massage procedures, light gymnastics, physiotherapy techniques, as well as diet and appropriate drinking regimen.

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