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Bowel movement is not exactly an easy conversation to bring up with friends and family. Yet, constipation is a common problem among urban folks, affecting an estimated 15-23% of women and approximately 11% of men in Asia.
If you’re having a tough time passing stools or cannot seem to completely empty your bowels, you are likely suffering from constipation.
According to the criteria used by doctors and healthcare professionals, a person must have experienced at least two of the following symptoms over the preceding three months: Fewer than three bowel movements per week, straining, lumpy or hard stools, sensation of anorectal obstruction, sensation of incomplete defecation, manual maneuvering required to defecate.
There are many different causes of constipation. Lack of sufficient fluids, dietary fibre, and a sedentary lifestyle is usually the cause, although there are many other reasons one could be having difficulty with bowel movement.
Laxatives can help provide relief to constipation. Consumer healthcare medical affairs lead Dr Ferawati of pharmaceutical company Sanofi-aventis provides insights into the common questions that surround the topic of laxatives.
How many types of laxatives are there?
In Malaysia, there are three main types of laxatives that can be bought over-the-counter (OTC), which are stimulant laxatives, bulk-forming laxatives, and osmotic laxatives, says Dr Fera.
Stimulant laxatives stimulates the nerves in your digestive tract to help quicken bowel movement. Bulk-forming laxatives works in a similar way as fibre does in your system by retaining fluid thus encouraging your bowels to push the stools out. Osmotic laxatives work increasing the water content in your bowels, thus softening your stools so that they are easily passed.
How long do laxatives take to work?
There is no hard and fast rule to this, as the answer varies based on the type of laxative being used. If you are taking stimulant laxatives suppositories, it can work as early as 20 minutes after consumption whereas bulk-forming laxatives take a while to see results, anywhere between 12 hours to three days.
Do laxatives have long-term side effects?
Most medications come with side effects, and laxatives are no exception. However, the side effects from laxatives are usually mild, says Dr Fera, and should cease when you stop taking the medication.
Among the usual side effects experienced from laxatives include bloating, passing wind, painful abdominal cramps, dehydration, and light-headedness. These side effects vary among different types of laxatives.
Are laxatives addictive?
One concern that many people have about laxatives is that the chronic use of the medication may cause addiction.
“Addiction is not common when using laxatives. For stimulant laxatives, studies have shown that long-term use of the laxative results in no habituation (ie, the reduction or even loss of response to laxatives) and no tolerance (ie, the need to increase the dose of laxatives to produce the desired response) even up to 34 years of usage,” says Dr. Fera.
However, consumers shouldn’t confuse addiction with abuse of laxatives.
“Some people think that taking laxatives will reduce weight, or psychologically they might think that if they don't use these laxatives they won't be able to empty their bowels,” says Dr. Fera.
These are very different issues all together. Laxatives should never be used for weight loss in any circumstance, and for long term use, it is recommended to follow the advice of your doctor.
Can dietary fibre replace the use of laxatives?
Consuming more fibre for the purpose of easing constipation does not always work.
Some constipated patients will do poorly with fibre supplements, such as those with constipation–predominant irritable bowel syndrome, idiopathic slow transit constipation, or primary defecation disorder.
“Certainly, regular exercise and increasing the amount of fibre and fluids consumed via diet are healthy lifestyle choices for most. But when it comes to chronic constipation, deficiencies in these areas are not usually the major concern,” says Dr. Fera.
She points out one study in 2006 which showed that 80% of constipated patients with slow transit and 63% with a disorder of defecation did not respond to dietary fibre treatment.
“Thus, fibre supplements should not be given indiscriminately to patients with chronic constipation or be aggressively increased in those who fail to respond appropriately. Patients should be monitored for discomfort, and fibre intake should be modified as needed,” she adds.
What type of laxative is right for me?
For first-time users or those who are not familiar with the use of laxatives, it all depends on your lifestyle needs, says Dr. Fera.
“If you're active and you want something fast, predictable and safe, go for stimulant laxatives tablets that relieve your constipation overnight or even suppositories which are faster than liquid or tablets.
“If you can wait a little more and want something more natural, then increase the intake of fibre in your diet. However, with this method, you’ll need to bear with the discomfort for another two days or so, especially if your constipation is already pronounced,” says Dr. Fera.
If you are keen on trying OTC laxatives as a solution to your constipation, Dr. Fera shares some tips to be mindful about:
●Take only the recommended amount on the medicine’s label. Don’t assume that more medicine will work better or quicker. Taking more than the recommended amount can be dangerous.
●If you are taking a prescription medicine, ask your doctor if it’s okay to also take an OTC laxative.
●In principle, do not take laxatives if you have an allergy to any of the ingredients.
●Remember, fibre might work for most people, but not for everyone. If increasing your fibre intake leaves you feeling more bloated and blocked than before, consult your doctor at once, as it could mean many different things.