If you have ever stood in a drug store and looked at all the available laxatives, you know how confusing it can be to make a good choice. There seem to be so many different types, and you do not have any idea which one is safer or better than the next. Before you purchase a laxative, hopefully, you have tried lifestyle changes to relieve the constipation. Often adding more fiber-rich food, liquid, and exercise to your daily routine will clear up the problem. If those measures have failed, it is time to look at over-the-counter remedies.

To begin with, laxatives come in two forms–those that can be taken orally and others that are inserted rectally. Oral laxatives can be bought as liquids, wafers, gums, powders or tablets, while rectal laxatives come in the form of suppositories or enemas. All laxatives can become habit forming and create a dependency which may increase constipation instead of curing it. When people consult a doctor about constipation, a prescription for laxatives is written 85 percent of the time. So it is important to understand the types of laxatives available, how they work and how to use them safely.

Great, now what ?

Laxatives work in various ways, and people can respond to the same laxative differently. Here are some laxatives, and how they are classified.

• Bulk-forming laxatives (often referred to as fiber supplements) are the gentlest on your body, and they are safe for long-term use. Metamucil and Citrucel are two examples of this type. This laxative absorbs water into the stool, forming bulk to aid movement through the intestines. Side effects can be bloating, gas and cramping, so it is important to drink plenty of fluids. If you take certain medicines, fiber can interfere with their absorption; these medicines are best taken an hour before or two hours after consuming fiber supplements. Introduce fiber gradually into your diet to avoid excessive gas and bloating.
• Osmotic and hyperosmolar laxatives draw fluids into the intestine from the surrounding tissue, softening the stool and making it easier to pass. Milk of Magnesia, Miralax®, and Kristalose® are examples of these types of a liquid laxative. It is important to drink a lot of water to help make the laxative effective and to prevent gas and cramps.
• Emollient laxatives (stool softeners) contain compounds that soften the stool. They can take up to a week to be effective, and are often used by women after giving birth, hemorrhoid sufferers, and patients recovering from surgery. Colace® and Kaopectate® are well-recognized brand names. Side effects can be stomach or intestinal cramping.
• Oral stimulants work by stimulating rhythmic contraction of the digestive tract, accelerating transit time of the stool. This type works quickly, but is harsher on the digestive system. Ex-Lax® and Senokot® are two popular brands. The drawbacks are that it can create dependency and weaken the bowel’s ability to move naturally. The side effects are possible cramping, diarrhea, nausea, belching, faintness, and urine discoloration.They should only be used for a short time.
• Rectal stimulants are inserted into the rectum (suppositories), causing the lining of the colon to produce rhythmic contractions, as it should do naturally, to move the stool along. If you need immediate relief, rectal stimulants work almost immediately. These laxatives are sold under brand names such as Fleet Bisacodyl® and Dulcolax.®  Rectal irritation, stomach discomfort, and cramping can be the side effects.If you have health conditions, you need to be careful of using laxatives. Consult your doctor for advice with the following medical problems: heart disease, high blood pressure, kidney disease, stomach pain, nausea, rectal bleeding or vomiting. Laxatives can effect medications that you are taking, causing some of them not to be absorbed into your system. Be sure not to exceed the recommended dosage unless advised by your doctor. An electrolyte imbalance can develop with oral and rectal laxatives after prolong use which can lead to weakness, confusion, abnormal heart rhythms, and seizures. If you are pregnant, consult your doctor about laxatives  because they can harm you and your baby.

When using a laxative to cure occasional constipation, remember these tips:

• If you need to use laxatives to be “regular,” use fiber first.
• Drink fluids and stay well hydrated when using laxatives. Avoid regular use of stimulant laxatives. They can limit your body’s ability to absorb vitamin D and calcium.
• If your problem with constipation continues, see your doctor. Constipation may be a warning sign of a more serious problem such as colon cancer, diabetes mellitus, or hypothyroidism, among others. Your doctor can evaluate your medical history, do a physical exam and laboratory tests, and determine the exact cause and solution for your constipation.

Written by, Joy Seeman

2009 Hemorrhoid Information Center