Abstract
Chronic constipation is a frequent complaint in clinical practice. It is usually amenable to laxatives, which are available with and without prescription. An overemphasis on evidence-based analysis and aggressive marketing of newly developed laxative agents has tilted the recommendations toward more expensive, but not necessarily more effective, agents. This review addresses each of the four classes of laxatives and provides suggestions about their appropriate use in clinical practice.
Similar content being viewed by others
References and Recommended Reading
Wald A: Pathophysiology, diagnosis, and current management of chronic constipation. NCP Gastroenterol Hepatol 2006, 3:90–100.
Higgins PDR, Johanson JF: Epidemiology of chronic constipation in North America: A systematic review. Am J Gastroenterol 2004, 99:750–759.
Locke GR, Pemberton JH, Phillips SF: AGA technical review on constipation. American Gastroenterological Association. Gastroenterology 2000, 119:1766–1778.
Anderson AS, Whichelow MJ: Constipation during pregnancy: Dietary fiber intake and the effect of fibre supplementation. Hum Nutr App Nutr 1985, 39:202–207.
Badiali D, Corazziani E, Habib FI, et al.: Effect of wheat bran in treatment of chronic nonorganic constipation. A double-blind controlled trial. Dig Dis Sci 1995, 40:349–356.
Graham DY, Moser SE, Ester MK: The effect of bran on bowel function in constipation. Am J Gastroenterol 1982, 77:599–603.
Ashraf W, Park F, Lof J, Quigley EM: Effects of psyllium therapy on stool characteristics, colon transit and anorectal function in chronic idiopathic constipation. Aliment Pharmacol Ther 1995, 9:639–647.
Ramkumar D, Rao SSC: Efficacy and safety of traditional medical therapies for chronic constipation: a systematic review. Am J Gastroenterol 2005, 100:1–36.
Tomlin J, Read NW: Laxative effects of ingestible plastic particles. Br Med J 1988, 297:1175–1176.
Lewis SJ, Heaton KW: Roughage revisited: The effect on intestinal function of inert plastic particles of different sizes and shape. Dig Dis Sci 1999, 44:744–748.
Cheskin LJ, Kamal N, Crowell MD, et al.: Mechanisms of constipation in older persons and effects of fiber compared with placebo. J Am Geriatr Soc 1995, 43:666–669.
McRorie JW, Daggy BP, Morel JG, et al.: Psyllium is superior to docusate sodium for treatment of constipation. Aliment Pharmacol Ther 1998, 12:491–497.
Hurden V, Viola R, Schroder C: How useful is docusate in patients at risk for constipation? A systematic review of the evidence in the chronically ill. J Pain Symptom Manage 2000, 19:130–136.
Hamilton JW, Wagner J, Burdick BB, Bass P: Clinical evaluation of methylcellulose as a bulk laxative. Dig Dis Sci 1988, 33:993–998.
Pers M, Pers B: A crossover comparative study with two bulk laxatives. J Intern Med Res 1983, 11:51–533.
Wald A: Is chronic use of stimulant laxatives harmful to the colon? J Clin Gastroenterol 2003, 36:386–389.
Muller-Lissner S, Kamm MA, Scarpignato C, Wald A: Myths and misconceptions about chronic constipation. Am J Gastroenterol 2005, 100:232–242.
Dunnick JK, Hailey JR: Phenolphthalein exposure causes multiple carcinogenic effects in experimental model systems. Cancer Res 1996, 56:4922–4926.
Coogan PF, Rosenberg L, Palmer JR, et al.: Phenolphthalein laxatives and risk of cancer. J Natl Cancer Inst 2000, 92:1943–1944.
Nusko G, Schneider B, Schneider I, et al.: Anthranoid laxative use is not a risk factor for colorectal neoplasia. Results of a prospective case control study. Gut 2000, 46:651–655.
Kienzle-Horn S, Vix JM, Schuijt C, et al.: Efficacy and safety of bisacodyl in the acute treatment of constipation: A double-blind, randomized, placebo-controlled study. Aliment Pharmacol Ther 2006, 23:1479–1488.
DiPalma JA, DeRidder PH, Orlando RC, et al.: A randomized, placebo-controlled, multicenter study of the safety and efficacy of a new polyethylene glycol laxative. Am J Gastroenterol 2000, 95:446–450.
Corazziari E, Badiali D, Bazzocchi G, et al.: Long-term efficacy, safety, and tolerability of low daily doses of isometric polyethylene glycol balanced solution (PMF-100) in treatment of functional chronic constipation. Gut 2000, 46:522–526.
Brandt LJ, Schoenfeld P, Prather CM, et al.: Systematic review on the management of chronic constipation in North America. Am J Gastroenterol 2005, 100(Suppl):S5–S22.
Attar A, Lemann M, Ferguson A, et al.: Comparison of a low dose polyethylene glycol electrolyte solution with lactulose for treatment of chronic constipation. Gut 1999, 44:226–230.
Freedman MD, Schwartz HJ, Roby R, et al.: Tolerance and efficacy of polyethylene glycol 3350/electrolyte solution versus lactulose in relieving opiate induced constipation: A double-blinded placebo controlled trial. J Clin Pharmacol 1997, 37:904–907.
Johanson J, Wald A, Tougas G, et al.: Effect of tegaserod in chronic constipation: A randomized, double-blind controlled trial. Clin Gastroenterol Hepatol 2004, 2:796–805.
Kamm M, Muller-Lissner S, Talley NJ, et al.: Tegaserod for the treatment of chronic constipation: A randomized, double-blind, placebo-controlled, multinational study. Am J Gastroenterol 2005, 100:372–382.
Lin SR, Ke MY, Luo JY et al.: A randomized double-blind, placebo-controlled trial assessing the efficacy and safety of tegaserod in patients from China with chronic constipation. World J Gastroenterol 2007, 13:732–739.
Lacy BE, Levy LC: Lubiprostone: a chloride channel activator. J Clin Gastroenterol 2007, 41:345–351.
Roarty TP, Weber F, Soykan I, McCallum RW: Misoprostol in the treatment of chronic refractory constipation: results of a long-term open label trial. Aliment Pharmacol Ther 1997, 11:1059–1066.
Lederle FA, Busch DL, Mattox KM, et al.: Cost effective treatment of constipation in the elderly: A randomized double-blind comparison of sorbitol and lactulose. Am J Med 1990, 89:597–601.
Rouse M, Chapman N, Matiapatra M, et al.: An open randomized parallel group study of lactulose versus isphagula in the treatment of chronic constipation in adults. Br J Clin Pract 1991, 45:28–30.
Quah HM, Ooi BS, Seow-Choen F, et al.: Prospective randomized crossover trial comparing fibre with lactulose in the treatment of idiopathic chronic constipation. Tech Coloproctol 2006, 10:111–114.
Mahadevan U, Kane S: American Gastroenterological Association Institute medical position statement on the use of gastrointestinal medications in pregnancy. Gastroenterology 2006, 131:278–282.
Mahadevan U, Kane S: American Gastroenterological Association Institute technical review on the use of gastrointestinal medications in pregnancy. Gastroenterology 2006, 131:283–311.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Wald, A. Appropriate use of laxatives in the management of constipation. Curr Gastroenterol Rep 9, 410–414 (2007). https://doi.org/10.1007/s11894-007-0051-y
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11894-007-0051-y