Anti Constipating Agents

Introduction
Anti-constipating agents, also known as laxatives or cathartics, are substances used to relieve
constipation and promote bowel movements. These agents work through various mechanisms to
either soften stool, increase stool volume, or stimulate intestinal peristalsis.
Laxatives

Laxatives, or anti-constipating agents, are classified based on their mechanisms of action. Here
are the main types:

1. Bulk-forming Laxatives:
o Examples: Psyllium (Metamucil), methylcellulose (Citrucel), polycarbophil
(FiberCon).
o Mechanism: These agents absorb water into the stool, increasing its bulk and
water content. The increased bulk stimulates peristalsis and promotes bowel
movements.
2. Stool Softeners (Emollients):
o Examples: Docusate sodium (Colace), docusate calcium (Surfak).
o Mechanism: These agents help mix water and fat with the stool, softening it and
making it easier to pass.
3. Osmotic Laxatives:
o Saline Laxatives:
 Examples: Magnesium hydroxide (Milk of Magnesia), magnesium citrate,
sodium phosphate.
 Mechanism: These draw water into the bowel from surrounding tissues,
increasing stool water content and volume, which stimulates bowel
movements.
o Hyperosmotic Agents:
 Examples: Polyethylene glycol (Miralax), lactulose, glycerin.
 Mechanism: These work by drawing water into the colon, softening the
stool and increasing bowel movement frequency.
4. Stimulant Laxatives:
o Examples: Bisacodyl (Dulcolax), senna (Senokot), cascara sagrada.
o Mechanism: These agents stimulate the nerves in the intestines to increase
peristalsis, which helps move the stool through the bowel.

Purgatives

Purgatives, also known as strong laxatives, are substances that induce vigorous bowel
movements and are typically used to relieve severe constipation or prepare the bowel for surgical
procedures or diagnostic tests. Here are five examples of purgatives along with their mechanisms
of action:
 1. Bisacodyl (Dulcolax)
o Mechanism: Bisacodyl is a stimulant laxative that works by stimulating the
enteric nerves to cause colonic contractions. This increases peristalsis, which
helps move the stool through the colon. It also promotes the accumulation of
water and electrolytes in the intestinal lumen, softening the stool and making it
easier to pass.
2. Senna (Senokot)
o Mechanism: Senna contains anthraquinone glycosides known as sennosides,
which are converted by intestinal bacteria into active compounds. These
compounds stimulate the muscles of the colon, increasing peristalsis and
promoting bowel movements. Senna also increases fluid secretion in the
intestines, which helps soften the stool.
3. Magnesium Citrate
o Mechanism: Magnesium citrate is an osmotic laxative that works by attracting
and retaining water in the intestine. The increased water content in the bowel
softens the stool and stimulates peristalsis, helping to promote bowel movements.
This can result in a rapid and thorough evacuation of the bowels.
4. Sodium Phosphate (Fleet Enema)
o Mechanism: Sodium phosphate acts as an osmotic laxative. It increases the
amount of water in the intestines by osmosis, drawing fluid into the bowel lumen.
This added water stimulates bowel movements by increasing the volume and
fluidity of the stool, leading to a rapid evacuation of the bowels.
5. Polyethylene Glycol (PEG) with Electrolytes (GoLYTELY)
o Mechanism: Polyethylene glycol with electrolytes is an osmotic laxative
commonly used for bowel cleansing before colonoscopy or surgery. It works by
retaining water in the stool, softening it, and increasing stool volume. The
presence of electrolytes helps prevent dehydration and electrolyte imbalance
while promoting complete bowel evacuation.

These purgatives are used under medical supervision to ensure safe and effective bowel
cleansing. The choice of purgative depends on the specific medical needs and the condition
being treated.

Common Pharmacological action of Laxatives

The common pharmacological action of laxatives involves facilitating bowel movements by

altering the water content, consistency, or motility of the stool and intestines. Here is a summary
of the general pharmacological actions shared by different types of laxatives:

1. Increasing Water Content in the Stool:

o Many laxatives work by drawing water into the intestines or retaining water in the
stool. This helps to soften the stool, making it easier to pass. Examples include
osmotic laxatives (like polyethylene glycol and lactulose) and bulk-forming
laxatives (like psyllium and methylcellulose).
2. Enhancing Intestinal Motility:
 o Some laxatives stimulate the muscles of the intestines to contract more frequently
and with greater force. This increased peristalsis helps move the stool through the
colon. Stimulant laxatives (such as bisacodyl and senna) and prokinetic agents
(like prucalopride) function this way.
3. Softening the Stool:
o Stool softeners, or emollients, work by allowing water and fats to penetrate the
stool, softening it and making it easier to pass. Docusate sodium is a common
example.
4. Lubricating the Stool and Intestinal Lining:
o Lubricant laxatives coat the stool and the lining of the intestines with a slippery
film, preventing water absorption from the stool and easing its passage through
the bowel. Mineral oil is a typical lubricant laxative.
5. Stimulating Fluid and Electrolyte Secretion:
o Certain laxatives increase the secretion of fluids and electrolytes into the intestinal
lumen. This helps to soften the stool and stimulate bowel movements. Chloride
channel activators (like lubiprostone) and guanylate cyclase-C agonists (like
linaclotide) are examples.

Overall, laxatives promote bowel movements through one or a combination of these

mechanisms, improving stool consistency, volume, and transit time through the intestines. The
specific action depends on the type of laxative used.

Constipation and its treatment

Constipation occurs when bowel movements become infrequent or difficult to pass. It can lead
to discomfort, bloating, and abdominal pain. Treatment often involves lifestyle changes, dietary
adjustments, and, when necessary, the use of anti-constipating agents. Here's an overview of
constipation treatment with anti-constipating agents:

1. Bulk-forming Laxatives

 Mechanism: These agents, such as psyllium (Metamucil) or methylcellulose (Citrucel),

work by absorbing water into the stool, increasing its bulk and moisture content. This
stimulates peristalsis and promotes regular bowel movements.
 Usage: They are generally safe for long-term use and are often recommended as first-line
treatment.

2. Stool Softeners (Emollients)

 Mechanism: Docusate sodium (Colace) and docusate calcium (Surfak) help water and
fats mix with the stool, making it softer and easier to pass.
 Usage: Especially useful for those who should avoid straining, such as post-surgery
patients or those with hemorrhoids.
3. Osmotic Laxatives

 Mechanism: These agents, like polyethylene glycol (Miralax) or lactulose, draw water
into the intestines, increasing stool water content and volume. This stimulates bowel
movements.
 Usage: Effective for quick relief; ensure adequate hydration to prevent electrolyte
imbalances.

4. Stimulant Laxatives

 Mechanism: Bisacodyl (Dulcolax) and senna (Senokot) stimulate intestinal nerve

endings, increasing peristalsis and bowel movements.
 Usage: Short-term use only due to potential dependence and decreased bowel function
with prolonged use.

5. Lubricant Laxatives

 Mechanism: Mineral oil coats the stool and intestinal lining, preventing water absorption
and easing stool passage.
 Usage: Not recommended for long-term use due to interference with nutrient absorption.

General Recommendations for Constipation Management

 Hydration: Drink plenty of water throughout the day.

 Fiber-Rich Diet: Increase fiber intake from fruits, vegetables, and whole grains.
 Regular Exercise: Physical activity helps stimulate bowel movements.
 Establish Regularity: Set aside time for bowel movements each day.
 Medical Evaluation: If constipation persists or is severe, consult a healthcare provider to
rule out underlying conditions.

Adverse effects of Anti Constipating Agents

Here are the adverse effects of laxatives and purgatives in brief:

1. Dehydration: Some laxatives can lead to excessive fluid loss, causing dehydration if not
enough water is consumed.
2. Electrolyte Imbalance: Osmotic laxatives may disrupt electrolyte balance, leading to
low levels of potassium, sodium, or magnesium.
3. Abdominal Cramps: Stimulant laxatives can cause abdominal discomfort, cramping,
and bloating.
4. Dependency: Prolonged use of certain laxatives, especially stimulant laxatives, can lead
to dependency, where the bowel becomes reliant on them for regular function.
5. Rectal Irritation: Lubricant laxatives like mineral oil can cause irritation and
inflammation of the rectum.
6. Nutrient Malabsorption: Mineral oil and certain other laxatives may interfere with the
absorption of fat-soluble vitamins, leading to deficiencies over time.
 7. Diarrhea: Osmotic laxatives and some purgatives may cause excessive bowel
movements and diarrhea.
8. Laxative Abuse: Misuse or overuse of laxatives can lead to laxative abuse, which can
further exacerbate bowel dysfunction and lead to serious health complications.
9. Gastrointestinal Distress: Some individuals may experience nausea, vomiting, or
flatulence as a side effect of laxative use.
10. Rectal Bleeding: In rare cases, the straining associated with stimulant laxatives or the
passage of hard stools can cause rectal bleeding or hemorrhoids.

Drug Interactions of Anti Constipating Agents

Here are the drug interactions of laxatives and purgatives in brief:

1. Decreased Absorption: Some laxatives, like mineral oil, may interfere with the
absorption of certain medications, especially fat-soluble vitamins and drugs requiring
adequate absorption for efficacy.
2. Electrolyte Imbalance: Osmotic laxatives can lead to electrolyte imbalances,
particularly if taken with other medications that affect electrolyte levels, such as diuretics
or corticosteroids.
3. Enhanced Effect: Certain medications, such as opioids, anticholinergic drugs, or other
constipating agents, may enhance the constipating effects of laxatives and purgatives,
potentially worsening constipation.
4. Toxicity: Stimulant laxatives may interact with medications that affect gastrointestinal
motility or increase the risk of toxicity, such as anticholinergic drugs, tricyclic
antidepressants, or antiarrhythmic medications.
5. Decreased Efficacy: Some medications, such as antacids or proton pump inhibitors, may
reduce the efficacy of certain laxatives by altering gastrointestinal pH or delaying drug
absorption.
6. Increased Bleeding Risk: Prolonged use of stimulant laxatives may increase the risk of
gastrointestinal bleeding, particularly when combined with anticoagulant or antiplatelet
medications.
7. Fluid Retention: Osmotic laxatives may potentiate the effects of drugs that cause fluid
retention, such as NSAIDs or corticosteroids, leading to edema or exacerbating heart
failure.
8. Interference with Diagnostic Tests: Laxatives and purgatives may interfere with the
results of diagnostic tests, such as fecal occult blood tests or colonoscopies, by altering
bowel function or stool consistency.

Choice and uses of laxatives and Purgatives

Choosing and using laxatives and purgatives effectively involves considering factors such as the
underlying cause of constipation, the severity of symptoms, and individual health conditions.
Here's a guide to help with the selection and use of these medications:

1. Identify the Underlying Cause:

  Determine if constipation is due to dietary factors, lack of physical activity, medications,
or underlying medical conditions such as irritable bowel syndrome (IBS) or
hypothyroidism.

2. Consider Severity and Duration:

 Mild, occasional constipation may respond well to lifestyle changes and over-the-counter
laxatives. For chronic or severe constipation, consult a healthcare provider for proper
evaluation and management.

3. Choose the Right Type of Laxative:

 Bulk-forming Laxatives: For individuals who need to increase fiber intake.

 Stool Softeners: Useful for those who experience discomfort or straining during bowel
movements.
 Osmotic Laxatives: Provide rapid relief for occasional constipation or bowel preparation
for medical procedures.
 Stimulant Laxatives: Reserved for short-term use when other options fail to produce
results.
 Lubricant Laxatives: Considered for individuals with dry, hard stools.
 Prokinetic Agents: Used for chronic constipation or when other treatments are
ineffective.

4. Consider Individual Factors:

 Age: Choose appropriate formulations for children, elderly individuals, or

pregnant/breastfeeding women.
 Health Conditions: Some laxatives may not be suitable for individuals with certain
medical conditions such as kidney disease, heart failure, or gastrointestinal disorders.
 Medications: Assess for potential drug interactions with other medications being taken.

5. Follow Dosage and Administration Instructions:

 Read and follow the package instructions carefully, including dosage, frequency, and
duration of use.
 Ensure adequate fluid intake when using osmotic laxatives to prevent dehydration.
 Avoid prolonged use of stimulant laxatives due to the risk of dependency and bowel
function impairment.

6. Monitor for Adverse Effects:

 Be aware of potential side effects such as dehydration, electrolyte imbalance, abdominal

cramps, or diarrhea.
 Discontinue use and consult a healthcare provider if adverse effects occur or if
constipation persists despite treatment.
7. Seek Medical Advice When Needed:

 Consult a healthcare provider if constipation is severe, chronic, or accompanied by other

concerning symptoms such as abdominal pain, rectal bleeding, or unintended weight loss.

8. Follow Up:

 Regularly review the effectiveness of treatment and adjust as needed.

 Use laxatives and purgatives as part of a comprehensive approach to managing
constipation, including dietary and lifestyle modifications.

By carefully choosing and using laxatives and purgatives based on individual needs and health
considerations, constipation can be effectively managed with minimal risk of adverse effects.
However, it's essential to consult a healthcare provider for personalized recommendations,
especially for chronic or severe constipation.