Over-the-counter laxatives: risks of use

Laxatives can help relieve and prevent constipation. However, not all laxatives are safe for long-term use. Overuse of laxatives can lead to dependence and decreased bowel function.

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How Laxatives Can Relieve Constipation

Laxatives work in different ways, and the effectiveness of each type of laxative varies depending on the individual’s body. Natural laxatives, also called fiber supplements, have substances that are gentle on the body, safe to use, and good for long-term treatment. Metamucil and Citrucel fall into this category. Stimulant laxatives, such as Ex-Lax and Senokot, are quite harsh and should not be used for long-term treatment.

While many laxatives are available over the counter, it's best to talk to your doctor about using a laxative and what type might be best for you.

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Over-the-counter laxatives

If you've ever experienced the discomfort of constipation—perhaps while traveling or after a change in your diet—you may have purchased over-the-counter laxatives. Over-the-counter laxatives come in many different forms—liquids, tablets, wafers, suppositories, or powders that dissolve in water. You can also choose rectal laxatives in the form of suppositories or enemas.

How often do you have a bowel movement? It can vary from a "normal" frequency of three bowel movements a day to three a week. Your body usually doesn't need help to have a bowel movement. But a poor diet, lack of exercise, pregnancy, liver disease, or certain medications can disrupt normal bowel function and cause constipation.

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Before you try taking a laxative

Before turning to laxatives to ease bowel movements, try these lifestyle changes to help manage occasional bowel movements.

• Eat foods rich in fiber such as wheat bran, fresh fruits and vegetables, and oats.
• Drink plenty of fluids throughout the day.
• Do physical exercise regularly.
• Lifestyle and dietary improvements can help relieve constipation for many people, but if problems continue to bother you despite these changes, a gentle laxative may be your next choice.

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Oral Laxatives Without Prescription

Oral laxatives can interfere with the absorption and utilization of some medications and foods. Rectal laxatives do not have this effect. In addition, some oral and rectal laxatives can cause electrolyte imbalances, especially after long-term use.

Electrolytes, which include calcium, chloride, potassium, magnesium, and sodium, regulate intestinal muscle contractions, heart rhythm, nerve function, fluid balance, and other body functions. Electrolyte imbalances can cause abnormal heart rhythms, weakness, confusion, and seizures.

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Complicating the conditions for taking laxatives

Just because laxatives are available over the counter doesn't mean they're safe to use. Laxatives can be dangerous if your constipation is caused by a serious condition, like appendicitis or a bowel obstruction. If you use certain laxatives frequently over weeks or months, they can reduce your colon's natural ability to contract and actually make your constipation worse.

Precautions for pregnant women and children

Laxatives should not be given to children under 6 years of age without a doctor's recommendation. If you are pregnant, you should consult a doctor before using laxatives. Mass-use laxatives and stool softeners are generally safe to use during pregnancy, but strong laxatives may harm you or your baby.

Castor oil is a stimulant laxative, which means it can cause uterine contractions, for example. If you've recently given birth, talk to your doctor before using laxatives. While they're generally safe to use while breastfeeding, some ingredients can pass into breast milk and cause diarrhea in nursing babies.

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Don't be weak with laxatives

Call your doctor if you have bloody stools, severe cramping, pain, weakness, dizziness, unexplained fatigue, or rectal bleeding. You should also call your doctor if you have unexplained changes in bowel habits or if constipation continues for more than seven days despite using laxatives. If you depend on laxatives, ask your doctor about ways to gradually wean yourself off them and restore your colon's natural ability to function.

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Allergy to laxatives

Tell your doctor if you have ever had any unusual or allergic reactions to this class of medicines or any other medicines. Also tell your doctor if you have any other allergies, such as to food dyes, preservatives, or animal allergies. When buying over-the-counter medicines, read the label or package.

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Pediatric Risks of Laxatives

Laxatives should not be given to young children (under 6 years of age) unless recommended by a doctor. Since children are usually unable to describe their symptoms well, they should be checked by a doctor before giving laxatives to children.

The child should have alternative treatment options other than laxatives. It is also possible to become addicted to laxatives. If this is the case, laxatives will not help and may even cause unwanted effects or make the child feel worse.

In addition, weakness, increased sweating, and convulsions (seizures) may be especially likely in children receiving enemas or rectal suppositories, as these children may be more sensitive than adults.

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Geriatric risks of laxatives

Weakness, increased sweating, convulsions (fits) may be especially likely in elderly patients, as they are more sensitive than younger people to the effects of rectal laxatives.

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Other medical problems

The presence of other medical problems (diseases) may affect the use of medicines, especially laxatives. Tell your doctor if you have any other medical problems, especially:

• Appendicitis (or its signs)
• Rectal bleeding of unknown etiology requires immediate medical attention.
• Stagnation of fecal matter in the colon - using laxatives can create other problems if a person has stool retention.

So, given all the risks of using laxatives, it is important to remember that it is advisable to resort to their help for constipation only in exceptional cases, so as not to harm the body.

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Laxative Combinations: Checking the Label

Some products combine different types of laxatives, such as a stimulant and a stool softener. Combination products may not be more effective than either of the targeted substances. But they may be more likely to cause side effects because of their multiple ingredients. Read labels and look carefully to see how many types of laxatives a product contains.

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Risk of laxative-drug interactions

Your medical history and other medications you take besides laxatives may limit your laxative options. Laxatives can interact with blood thinners such as warfarin (Coumadin), antibiotics such as tetracycline, and certain heart and bone medications.

Before using any laxative, read the labels very carefully. If you are not sure whether a particular laxative is right for you, ask your pharmacist or doctor. Do not exceed the dose recommended by your doctor.

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Interaction of laxatives with drugs

Although some medications should not be used together, in some cases two different medications can be used together even though they may interact. In these cases, your doctor may change your dose or take other measures. Tell your doctor if you are taking any other prescription or over-the-counter medications.

Some medications should not be used with food or certain types of food because their ingredients may interact. Drinking alcohol or smoking with certain medications may also cause adverse reactions. Talk to your doctor about using your medication with food, alcohol, or smoking.