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Laxatives For Constipation (cont.)

Saline Laxatives

The active ingredients in saline laxatives are mostly magnesium, sulfate, citrate, and phosphate ions. These ions draw water into the intestines. The additional water softens the stool, increases pressure within the intestines, and increases intestinal contractions resulting in the discharge of softer stool. Fleet Phospho-Soda, milk of magnesia, and magnesium citrate are examples of saline laxatives.

Oral doses of saline laxatives should be taken with one to two glasses of water. The onset of bowel response is usually 1/2 to 3 hours after consuming the laxative. Small doses are sometimes recommended for the treatment of occasional constipation, while larger doses can produce complete evacuation of the intestine. Complete cleansing of the bowel is useful in preparing for colonoscopy, sigmoidoscopy, and barium enema.

Precautions

Since there may be some absorption of the active ingredients from the intestines into the blood circulation, saline laxatives should not be used in certain patients. Patients with impaired kidney function should not use laxatives containing magnesium or phosphate salts. Excess accumulation of magnesium and phosphate in the blood of these patients can lead to toxicity. Patients who need to limit their sodium intake, such as those with congestive heart failure, kidney disease, and high blood pressure, should not use laxatives that contain sodium.

Enemas and Suppositories

Rectally administered enemas and suppositories are commonly used to cleanse the rectum and the sigmoid colon (the part of the colon closest to the rectum) prior to surgery, child delivery, and flexible sigmoidoscopy. Enemas and suppositories are also used to relieve constipation and rectal fecal impaction (blockage of the rectum by hard, compacted stool). They can also be used in conjunction with oral laxatives in cleansing the colon in preparation for barium enema studies.

Enemas and suppositories include  docusate (Microenema), bisacodyl (Dulcolax Suppository), and sodium phosphate (Fleet Enema). These products are intended for occasional use and are not recommended as a chronic laxative regimen unless directed by a physician.

Patients should carefully follow instructions in using enemas. The patient should lie on the left side with the knees bent. The enema solution should be inserted slowly into the rectum. The person should retain the solution in the rectum until definite rectal pressure and the urge to have a bowel movement are felt. Evacuation usually occurs within minutes to an hour.

Precautions

  • Soapsuds enemas can cause rectal irritation and sometimes rectal gangrene. Therefore, soapsuds enemas are not recommended.

  • Enema solutions can cause fluid and electrolyte disturbances in the blood if used on a chronic basis.


Next: Laxatives for Constipation At A Glance »

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