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Thread: Laxatives

  1. #1
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    Laxatives

    When using a laxative are some more intrusive than others? Are the differences between using a dulcolax tablet, citrate of magnesium or some other type? And for the dependence to occur, how frequently would you have to use them? The label warns you about becoming dependent on laxatives.

    I have just started using colace this year because of the narcotics I am taking. . I am already dependent upon suppositories for stimulation, what are the differences and dangers of using more aggressive laxatives? How frequent would you have to take a more aggressive laxative before having concerns, three times a year ,six times a year?

  2. #2

    Softeners, stimulants and laxatives

    I personally divide these medications into these three different categories, as in many ways they work differently.

    A softener (Colace, Surfax, Dialose, etc.) works as a wetting agent. It prevents your body from absorbing too much water from your stool (will only work if you are also well hydrated). There is no indication that there is any adverse effects of the use of these medications over the long term.

    A stimulant (senna, cascera, bisacodyl, etc.) increases the muscle contractions inside the intestines, moving stool down the GI tract faster, resulting in less drying of stool. Regular use (more than 1-2X monthly) over years may lead to a higher risk of megacolon, similar to the use of routine enemas. Short term regular use (for example, when taking narcotics when recovering from surgery) probably is not harmful.

    A laxative (milk of magnesia, magnesium citrate, lactulose, etc.) may increase peristalsis or muscle contractions some, but it primarily works by pulling water from your body into the intestine by osmotic action, softening stool and making you evacuate due to the increased volumn of stool inside the intestine. Again, regular use (more than 1-2X monthly) over years may lead to a higher risk of megacolon.

    Bulk agents such as psyllium or calcium polycarbophyl increase muscle contraction by increasing the size of the stool. There is no indication that long term use of these has any adverse effects.

    (KLD)

  3. #3
    Senior Member ~Patrick~'s Avatar
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    Colace or pericolace

    Cris, I had no luck when I used the colace(stool softener) so I started the pericolace (stool softener and laxative). I have had good results with this. My b.p. is every other day and I take it on the night before and the day of.

    ...act like a survivor not a victim.

  4. #4
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    Excuse me, but what is megacolon and why is it bad? I infer that if I use laxative less than 12 times year, i should not become dependant or have any adverse effect?

  5. #5

    Megacolon

    Megacolon is a relatively rare condition in adults that can occur in people with SCI as they get older. It is seen the most in people with higher lesions, in injuries older than 20 years, and those who have used regular enemas, stimulants and laxatives for years.

    In megacolon (big colon) the large bowel appears stretched out and distended with no muscle tone. The normal rugae (undulations of the shape of the bowel) smooth out, and the bowel has very little contraction. Xrays will reveal large amounts of stool in the bowel. Normal bowel transit time (8-24 hours in AB, up to 72 hours in SCI) may extend as long a 2 weeks. The result is often increased problems with constipation, prolonged evacuation times for bowel care, bloating, ileus and sometimes fairly severe AD.

    Formerly the drug cisapride was sometimes used to treat it, but it was taken off the market in the USA due to cardiac side effects. The only treatment is to use more and more stimulants to try to "perk up" the bowel, use of more enemas, or more often a colostomy is needed.

    In children, megacolon is seen in Hirshsprung's disease, where babys are born with an absence of the normal autonomic nerves responsible for peristalsis (bowel muscle movement).

    (KLD)

  6. #6
    Senior Member alan's Avatar
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    Unfortunately, I've been using laxatives (mainly senokot the night before my program since the beginning in '81 (actually, I left rehab on them daily, but cut down.) I'd guess it's too late to stop using them?

  7. #7

    Long term use

    Unfortunately by this time your bowel is probably pretty dependent upon the use of strong stimulants. Are you finding that you are having to use increasing amounts?

    (KLD)

  8. #8
    Senior Member alan's Avatar
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    I haven't been increasing the amount of laxative, except when on a constipating medicine. The bowel program almost always requires digital intervention, but that's not new.

  9. #9
    I'm another long time senna user. In rehab back in '90 it was routine for us all to be given a large dose of senna the night before the BP. For 12 years I have taken 25ml of senna granules every other night, that is the equivilant to taking 10 senna tablets.

    I am now trying to switch to using lactulose instead of senna, although it's still a 'risky' med, it's less harse on the bowel than the senna. So far I'm down to 10ml of senna + 15ml of lactulose the night before BP. Each week I reduce the senna by 5ml with a goal of only requiring 20ml of lactulose the night before. I honestly don't think my bowel will function with anything less.

    Do I have stomach problems? Yes, I do. The right hand side of my bowel has sluggish bowel sounds (the left sounds fine) and the upper right swells up and becomes painful during the 48 hour between BPs. The pain is relieved after an evacuation.

    Isn't life with SCI and bowels fun? :/


    Andy.

    --
    To reply to me via email, replace 'spambucket' with 'andy'.

  10. #10

    Triphala works best for me

    Triphala is an Indian herb made of three fruits. It is very mild (unlike senna or cascara) but very effective and supposedly non-habit forming. Here is an excerpt from an article about Triphala. Maybe SCI-Nurse has heard of this before - I'd love to hear any feedback since I use this herb at least on a weekly basis.


    "Triphala, as it is called, is the most popular Ayurvedic herbal formula of India, since it is an effective laxative which also supports the body's strength. The constitution of vegetarian Hindus cannot tolerate harsh laxatives anymore than vegetarians in other countries. Because of its high nutritional value, Triphala uniquely cleanses and detoxifies at the deepest organic levels without depleting the body's reserves. This makes it one of the most valuable herbal preparations in the world.

    How is Triphala different from other kinds of laxatives? There are two primary types of herbal laxatives. One is called a purgative and includes herbs such as senna, rhubarb, leptandra, buckthorne and cascara. These often contain bitter principles in the form of anthroquinones which work by stimulating the peristaltic action of the intestinal lining, either directly or by promoting the secretion of bile through the liver and gall bladder.

    The second type of laxative is a lubricating bulk laxative, including demulcent herbs such as psyllium and flax seed. This is more nutritional and usually does not have any significant direct effect on either the liver or the gall bladder. Rather, these work like a sponge by swelling and absorbing fluid, thus acting as an intestinal broom.

    Triphala combines both nutritional as well as blood and liver cleansing actions. It has little function as a demulcent or lubricating laxative, however. It possesses some anthroquinones which help stimulate bile flow and peristalsis. The nutritional aspect is more in the form of its high vitamin C content, the presence of linoleic oil and other important nutrients which it makes more of a tonic."

    [This message was edited by Jan on Oct 07, 2002 at 12:33 AM.]

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