What’s the best bowel regimen? What are the different types of laxatives? 

Because people are reluctant to talk about their bowel movements, there’s a lot of confusion about what you should do to keep things running on time. One of the most commonly misused drugs are the laxatives, so I thought I’d post about them today.

  • Fiber: a first-line agent because it helps with constipation AND diarrhea. It’s not a laxative per se: it makes bowel movements more regular. Fiber absorbs water in your colon and makes the stool bulky and soft. Our bodies are evolutionarily adapted for a fiber-rich diet, but these days, most of us don’t consume nearly enough fiber for our body to figure out how to get rid of all the stool in the most efficient way. (Here’s a general list of foods high in fiber from the Mayo Clinic.) Fiber supplements like psyllium, methylcellulose, and polycarbophilcan (in Metamucil or Citrucel) help. They are found in powdered and pill forms; the powdered form is not exactly palatable, but considering that you’d have to take about 10 pills/day, most people find the powdered form easier. The trick is to take the fiber every single day, with plenty of water. It takes about a week to reach its full effect, and it’s common to experience bloating, gas, and sometimes nausea.
  • Stimulatory: like senna, cascara, or bisacodyl are relatively harsh agents that cause more bowel movements by irritating the lining of your gut. They are a quick fix, but not a good long-term solution because the irritation can eventually make your gut function worse than it was before. Do not take stimulant laxatives for long periods of time, because it will only make constipation worse.
  • Osmotic agents: like docusate (Colace) or Ex-Lax work by pulling water from your tissues into your gut, making the stool softer. Because they pull water out, they are more likely to cause dehydration, electrolyte imbalances, and are not good for anyone with impaired kidney function. They shouldn’t be taken for more than three days at a time.
  • Lubricants:  as the name implies, lubricates the stool, making it softer. Good examples are glycerin suppositories or mineral oil. These can be effective, but take a lot more time/work than other treatments, as you might imagine. Using mineral oil too frequently can cause toxic buildup.

The one thing that we never want to see laxatives used for is eating disorders. There are some scary statistics and personal stories about people with anorexia and/or bulimia who have used laxatives in order to lose weight or “purge.” (I’ve also anecdotally heard that some athletes and dancers, overwhelmingly women, use laxatives.) It is hard to believe, but there are threads on Yahoo! asking which laxatives are the best to use for weight loss, or which laxative bulimics have had the most success with.

It is obvious that abusing laxatives is a Bad Thing, but why? Laxatives deplete your body of water and essential electrolytes, which can have neurological and metabolic consequences. Over time, one’s body can develop tolerance to laxatives and impair gut function, raising the risk of bowel obstruction and constipation, which defeats the point of using laxatives in the first place. The basic message: never use laxatives for any purposes other than a medically indicated reason.

For more information about the mechanism of action of laxatives, see this GroundReport article.

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