Skip to main content

Constipation—modern laxative therapy


It is estimated that one third of the population in Western industrial countries suffers from constipation at least from time to time. Constipation may have somatopathic or functional causes. Furthermore, a great number of substances are known to cause medication-induced constipation, i.e. opioid-induced constipation is caused by linkage of the opioid to opioid receptors in the bowel and the central nerve system. Whenever possible, causal therapy should be undertaken. Patients in palliative care mostly suffer from chronic functional constipation. The treatment consists of basic measures and the application of laxatives. According to their mode of action, they are divided into bulk-forming laxatives, osmotic laxatives, stimulant laxatives, lubricating agents and others. Bulk-forming laxatives are not recommended for use in palliative care patients, for such patients are normally not able to take in the required amount of fluids. Osmotic laxatives are divided into (magnesium) salts, saccharine, alcohols and macrogols. Lactulose is the most popular saccharine laxative. Because of its side effects (flatulence, bloating and abdominal cramping), lactulose is not a laxative of our choice; instead, we prefer to give macrogol. Orally administered, macrogol is not metabolised and pH value and bowel flora remain unchanged. Macrogol hydrates hardened stools, increases stool volume, decreases the duration of colon passage and dilates the bowel wall that then triggers the defecation reflex. Even when given for some time, the effectiveness of macrogol will not decrease. Because of its high effectiveness and commonly good tolerance, macrogol has become the laxative of first choice in palliative care patients with all kinds of chronic constipation, if these patients are able to take in the necessary amount of fluids. From the general medical point of view, lubricating agents have become obsolete. In palliative care patients, however, they are still important laxatives for prophylactic treatment or therapy of constipation. Due to clinical experience, in palliative care a laxative ladder has proven successful.

This is a preview of subscription content, access via your institution.

Fig. 1.
Fig. 2.
Fig. 3.
Fig. 4.
Fig. 5.


  1. Cleveland M, Flavin DP, Ruben R A, Epstein RM, Clark GE (2001) New polyethylene glycol laxative for treatment of constipation in adults: a randomized, double-blind, placebo-controlled study. South Med J 94(5):478–481

    CAS  PubMed  Google Scholar 

  2. Corazziari E, Badiali D, Bazzochi G, Basotti G, Roselli P, Mastropaolo G, Luca MG, Galeazzi R, Peruzzi E (2000) Long-term efficacy, safety and tolerability of low daily doses of isoosmotic polyethylene glycol electrolyte balanced solution (PMF-100) in the treatment of functional chronic constipation. Gut 46:522–526

    Article  CAS  PubMed  Google Scholar 

  3. Goerg K J, Wanitschke R, Loew D (1997) Obstipation und Laxanzien—eine Standortbestimmung, Der Allgemeinarzt. Fortbildung und Praxis für den Hausarzt. Kirchheim Verlag, Mainz. 19. Jg., 1+2, reprint

  4. Hammer HF, Hammer J, Gasche C (2000) Polyäthylenglykol (Macrogol)—Übersicht über seine Verwendung in der Diagnostik und Therapie gastroenterologischer Erkrankungen. Wien. Klein. Wochenschr. 112:53–60

    Google Scholar 

  5. Heaton KW, O'Donnell LJ, Braddon FE, Mountford RA, Hughes RO, Cripps PJ (1992) Symptoms of irritable bowel syndrome in a British urban community: consulters and nonconsulters. Gastroenterology 102:1962–1967

    CAS  PubMed  Google Scholar 

  6. Jurna I, Baldauf J (1993) Retardiert freigesetztes Naloxon oral: Aufhebung der Obstipation durch orales Morphin ohne Beseitigung der Analgesie. Der Schmerz 7:314–321

    Google Scholar 

  7. Kaufman PN, Krevsky B, Malmud LS, Maurer AH, Somers MB, Siegel JA, Fisher RS (1998) Role of opiate receptors in the regulation of colonic transit. Gastroenterology 94:1351–1356

    Google Scholar 

  8. Klauser AG, Mühldorfer BE, Vorderholzer WA, Wenzel G, Müller-Lissner SA (1995) Polyethylene glycol 4000 for slow transit constipation. Gastroenterology 33:5–8

    CAS  Google Scholar 

  9. Lasch HM, Bozymski EM (2000) A new weapon for the arsenal in the war against constipation? Am J Gastroenterol 95:341–342

    Article  CAS  PubMed  Google Scholar 

  10. Latasch L, Zimmermann M, Eberhardt B, Jurna I (1997) Aufhebung einer Morphin-induzierten Obstipation durch orales Naloxon. Anaesthesist 46:191–194

    Article  CAS  PubMed  Google Scholar 

  11. Locke GR III (1996) The epidemiology of functional gastrointestinal disorders in north America. Gastroenterol Clin North Am 25:1–19

    PubMed  Google Scholar 

  12. Müller-Lissner S (1992) Nebenwirkungen von Laxantien. Z Gastroenterology 30:418–427

    Google Scholar 

  13. Müller-Lissner S, Beil W (2001) Moderne Therapie mit Laxantien, unter Mitarbeit von Erckenbrecht JF, Wagner S. UniMed Verlag. Bremen

  14. Sonnenberg A, Koch TR (1989) Epidemiology of constipation in the United States. Dis Colon Rectum 32:1–8

    CAS  PubMed  Google Scholar 

  15. Stewart WF, Liberman JN, Sandler RS, Woods MS, Sternhagen A, Chee E, Lipton RB, Farup CE (1999) Epidemiology of constipation (EPOC) Study in the United States: Relation of clinical subtypes to socioeconomic features. Am J Gastroenterol 94:3530–3539

    Article  CAS  PubMed  Google Scholar 

  16. Sykes N (1998) The treatment of morphine-induced constipation. European Journal of Palliative Care 5(1):12–15

    Google Scholar 

  17. Talley NJ, Weaver AL, Zinsmeister AR (1993) Functional constipation and outlet delay. A population-based study. Gastroenterology 105 781–790

    Google Scholar 

  18. Willweber-Strumpf A, Zenz M, Tryba M (1995) Leitlinien zur Therapie chronischer Schmerzen mit Opioiden. Anaesthesist 44:719–723

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to E. Klaschik.

Additional information

Presented as an invited lecture at the 15th International Symposium Supportive Care in Cancer, Berlin, Germany, June 18–21, 2003.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Klaschik, E., Nauck, F. & Ostgathe, C. Constipation—modern laxative therapy. Support Care Cancer 11, 679–685 (2003).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • Constipation
  • Physiology
  • Therapy
  • Laxatives
  • Opioids
  • Palliative medicine