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Laxatives (or purgatives) are foods, compounds, or drugs taken to induce bowel movements or to loosen the stool, most often taken to treat constipation. Constipation, costiveness, or irregularity, is a condition of the Digestive system in which a person (or animal experiences hard Feces that Certain stimulant, lubricant, and saline laxatives are used to evacuate the colon for rectal and bowel examinations, and may be supplemented by enemas in that circumstance. The colon is a storage tube for solid wastes The main function of the colon appears to be extraction of Water and salts from Feces. The rectum (from the Latin rectum intestinum, meaning straight intestine) is the final straight portion of the Large intestine in some Mammals An enema (plural enemata or enemas) is the procedure of introducing liquids into the Rectum and colon via the Anus. Sufficiently high doses of laxatives will cause diarrhea. In Medicine, diarrhea, also spelled diarrhoea (see spelling differences) is frequent loose or liquid Bowel movements Acute diarrhea Laxatives only work to hasten the elimination of undigested remains of food in the large intestine and colon. The large intestine is the last part of the Digestive system: the final stage of the Alimentary canal in Vertebrate Animals Its function is to

There are several types of laxatives, listed below. Some laxatives combine more than one type of active ingredient to produce a combination of the effects mentioned. Laxatives may be oral or in suppository form. In Pharmacology and Toxicology, a route A suppository is a drug delivery system that is inserted either into the Rectum (rectal suppository Vagina (vaginal suppository or Urethra (urethral

Constipation with no known organic cause, i. e. no medical explanation, exhibits gender differences in prevalence: females are more often affected than males. An explanation is a description which may clarify causes context, and Consequences of a certain object and a phenomenon such as a process, a Gender comprises a range of differences between men and women extending from the biological to the social In Epidemiology, the prevalence of a Disease in a Statistical population is defined as the total number of cases of the disease in the population at a given [1] Not surprisingly, some advertisers promote their brands as being more feminine and thereby tailor their message to the market. The way laxatives function in males and females, however, does not exhibit significant differences.

Contents

Vegetables and foods

Some vegetables and foods can be eaten to cure constipation and act as laxatives, although the effectiveness may vary. These include:

Bulk-producing agents

Also known as bulking agents or roughage, these include dietary fiber. The Almond ( Prunus dulcis, syn Prunus amygdalus Batsch Amygdalus communis L Aloe vera, also known as the Medicinal Aloe, is a species of Succulent plant that probably originated in northern Africa. Apple juice is the Fruit juice product manufactured from the pressing of Apples Production Apple juice is produced by the crushing of apples The beet or beetroot is a Flowering plant species ( Beta vulgaris) in the family Chenopodiaceae. Broth is a Liquid in which Bones Meat, Fish, Cereal grains or Vegetables have been simmered and strained out Common Chicory ( Cichorium intybus) is a bushy perennial Herb with blue lavender or occasionally white Flowers It grows Chocolate ( pronounced or /-ˈələt/ comprises a number of raw and processed foods that are produced from the seed of the tropical Cacao tree The Coconut Palm ( Cocos nucifera) is a member of the Family Arecaceae (palm family CoFFEE is an Open source Software for computer supported collaborative learning (CSCL in a digital classroom The Apricot ( Prunus armeniaca, "Armenian plum" in Latin syn Description An Eclipse mint is an oval prism rounded at top Endive (ˈɛndiv or /ˈɛndɪv/ Cichorium endivia is a Leaf vegetable belonging to the daisy family. Ficus is a Genus of about 850 Species of woody Trees Shrubs Vines Epiphytes and hemi-epiphytes in the family Flax (also known as common flax or linseed) (binomial name Linum usitatissimum) is a member of the genus Linum For the Tokyo University supercomputer see Gravity Pipe. GRAPE, or GRA phics P rogramming E nvironment is Tea refers to the cured agricultural product of the leaves leaf buds and internodes of Camellia sinensis, which have been prepared and cured for the market Liquorice (UK or licorice (US (see spelling differences;, or) is the root of Glycyrrhiza glabra, from which a sweet flavour can be extracted Mangoes belong to the genus Mangifera, consisting of numerous species of tropical fruiting Trees in the Flowering plant family Anacardiaceae Molasses or Treacle is a thick Syrup by-product from the processing of the Sugarcane or Sugar beet into Sugar. The Olive ( Olea europaea) is a Species of small Tree in the family Oleaceae, native to the coastal areas of the eastern The papaya (from Carib via Spanish) is the Fruit of the Plant Carica papaya, in the genus Carica. Parsley ( Petroselinum crispum) is a bright Green, biennial Herb, also used as Spice. The peach ( Prunus persica) is a species of Prunus native to China that bears an edible juicy fruit also called a peach The Apricot ( Prunus armeniaca, "Armenian plum" in Latin syn A pear is a pomaceous Fruit produced by a tree of Genus Pyrus. This article refers to the edible fruit For the British construction company see Persimmon plc; for the racehorse see Persimmon (horse. Pineapple ( Ananas comosus) is the common name for an edible Tropical Plant and also its Fruit It is native to the southern part of Brazil A plum or gage is a stone fruit Tree in the genus Prunus, subgenus Prunus. A prune is any of various of various Plum species mostly Prunus domesticus or European Plum (commonly referred to as a Sugar Plum Rheum is a genus of Perennial plants that grows from thick short Rhizomes The genus is in the family Polygonaceae, and includes the vegetable For similar vegetables also called "turnip" see Turnip (disambiguation. Walnuts (genus Juglans) are Plants in the family Juglandaceae. Watercresses ( Nasturtium officinale, N microphyllum; formerly Rorippa nasturtium-aquaticum, R Not to be confused with Cilium. For the mucilaginous health product see Psyllium seed husks. Metamucil is a bulk-producing Laxative and fiber supplement manufactured by Procter & Gamble. Polycarbophil, also Calcium Polycarbophil is the International Nonproprietary Name of a synthetic polymer the calcium salt of Polyacrylic acid cross-linked Dietary fibers are the indigestible portion of plant foods that move food through the Digestive system, absorbing water and easing Defecation. The apple is the pomaceous Fruit of the apple tree Species Malus domestica in the Rose family Rosaceae. Dietary fibers are the indigestible portion of plant foods that move food through the Digestive system, absorbing water and easing Defecation. Bulk-producing agents cause the stool to be bulkier and to retain more water, as well as forming an emollient gel, making it easier for peristaltic action to move it along. Emollients are substances that soften and soothe the Skin. They are used to correct dryness and scaling of the skin In the Esophagus After food is chewed into a bolus it is swallowed to move it into the esophagus They should be taken with plenty of water. Bulk-producing agents have the gentlest of effects among laxatives and can be taken just for maintaining regular bowel movements.

Stool softeners / Surfactants

These cause water and fats to penetrate the stool, making it easier to move along. Docusate (ˈdɒkjuːseɪt is the generic name of a Surfactant used as a Laxative and Stool softener Docusate is also any of a group of anionic surfactants Many of these quickly produce a tolerance effect and so become ineffective with prolonged use. Their strength is between that of the bulk producers and the stimulants, and they can be used for patients with occasional constipation or those with anorectal conditions for whom passage of a firm stool is painful. Constipation, costiveness, or irregularity, is a condition of the Digestive system in which a person (or animal experiences hard Feces that

Lubricants / Emollient

These simply make the stool slippery, so that it slides through the intestine more easily. An example is mineral oil, which also retards colonic absorption of water, softening the stool. Mineral oil or liquid Petroleum is a By-product in the Distillation of Petroleum to produce Gasoline and other petroleum Mineral oil may decrease the absorption of fat-soluble vitamins and minerals.

Hydrating agents (osmotics)

These cause the intestines to hold more water within, softening the stool. There are two principal types, saline and hyperosmotic.

Saline

Saline laxatives attract and retain water in the intestinal lumen, increasing intraluminal pressure and thus softening the stool. They will also cause the release of cholecystokinin, which stimulates the digestion of fat and protein. Cholecystokinin ( CCK; from Greek chole, "bile" cysto, "sac" kinin, "move" hence move the bile-sac Saline laxatives may alter a patient's fluid and electrolyte balance.

Sulfate salts are considered the most potent.

Hyperosmotic agents

Lactulose works by the osmotic effect, which retains water in the colon, lowering the pH and increasing colonic peristalsis. pH is the measure of the acidity or alkalinity of a Solution. Lactulose is also indicated in Portal-systemic encephalopathy. Hepatic encephalopathy (sometimes hepatoencephalopathy) is a potentially-reversible Neuropsychiatric abnormality in the setting of Liver failure, whether Glycerin suppositories work mostly by hyperosmotic action, but also the sodium stearate in the preparation causes local irritation to the colon.

Solutions of polyethylene glycol and electrolytes (sodium chloride, sodium bicarbonate, potassium chloride, and sometimes sodium sulfate) are used for whole bowel irrigation, a process designed to prepare the bowel for surgery or colonoscopy and to treat certain types of poisoning. For sodium chloride in the diet see Salt. Sodium chloride, also known as common salt, table salt, or Halite, is a Sodium bicarbonate or sodium hydrogen carbonate is the Chemical compound with the formula NaHCO3 The Chemical compound potassium chloride (KCl is a Metal Halide salt composed of Potassium and Chlorine. Sodium sulfate is the Sodium salt of Sulfuric acid Whole bowel irrigation ( WBI) is a medical process involving the rapid administration of large volumes of an osmotically balanced Polyethylene glycol solution Colonoscopy is the endoscopic examination of the large colon and the distal part of the small bowel with a CCD camera or a Fiber optic Brand names for these solutions include GoLytely, GlycoLax, CoLyte, NuLytely, and others.

Effectiveness

For adults, a randomized controlled trial found PEG [MiraLax or GlycoLax] 17 grams once per day better than tegaserod 6 mg twice per day. A randomized controlled trial (RCT is a type of scientific Experiment most commonly used in testing the Efficacy or Effectiveness of Healthcare Poly( Ethylene glycol) (PEG also known as poly( Ethylene oxide) (PEO or polyoxyethylene (POE is the most commercially important type of polyether Tegaserod is a 5-HT 4 Agonist manufactured by Novartis and used for the management of Irritable bowel syndrome and Constipation [2] A randomized controlled trial found greater improvement from 2 sachets (26 grams) of PEG versus or 2 sachets (20 grams) of lactulose [3]. A randomized controlled trial (RCT is a type of scientific Experiment most commonly used in testing the Efficacy or Effectiveness of Healthcare Poly( Ethylene glycol) (PEG also known as poly( Ethylene oxide) (PEO or polyoxyethylene (POE is the most commercially important type of polyether Lactulose is a synthetic Sugar used in the treatment of Constipation and Hepatic encephalopathy, a complication of Liver disease. 17 grams/day of PEG has been effective and safe in a randomized controlled trial for six months. Poly( Ethylene glycol) (PEG also known as poly( Ethylene oxide) (PEO or polyoxyethylene (POE is the most commercially important type of polyether A randomized controlled trial (RCT is a type of scientific Experiment most commonly used in testing the Efficacy or Effectiveness of Healthcare [4] Another randomized controlled trial found no difference between sorbitol and lactulose [5]. A randomized controlled trial (RCT is a type of scientific Experiment most commonly used in testing the Efficacy or Effectiveness of Healthcare Sorbitol, also known as glucitol, is a Sugar alcohol that the body metabolises slowly Lactulose is a synthetic Sugar used in the treatment of Constipation and Hepatic encephalopathy, a complication of Liver disease.

For children, PEG was found to be more effective than lactulose. Poly( Ethylene glycol) (PEG also known as poly( Ethylene oxide) (PEO or polyoxyethylene (POE is the most commercially important type of polyether Lactulose is a synthetic Sugar used in the treatment of Constipation and Hepatic encephalopathy, a complication of Liver disease. [6]

Stimulant / Irritant

Onset of Action Laxative Name
6 - 8 hours Cascara
Phenolphthalein (Formerly in Ex-lax but phased out because of carcinogenicity concerns)
6 - 10 hours Bisacodyl tablets (Dulcolax)
Casanthranol
Senna (Ex-lax)
Aloe Vera
2 - 6 hours Castor oil
15 min - 1 hour Bisacodyl suppository

Microlax

These stimulate peristaltic action and can be dangerous under certain circumstances. For the genus Hippophae, see Sea-buckthorn. The Buckthorns ( Rhamnus) are a genus (or two genera if Frangula Phenolphthalein is a Chemical compound with the formula C 20 H 14 O 4 (often written as " HIn The term carcinogen refers to any substance Radionuclide or radiation that is an agent directly involved in the promotion of Cancer or in the fatation of its propagation Bisacodyl ( INN) is a stimulant Laxative drug It is typically prescribed for relief of Constipation and for the management of neurogenic bowel dysfunction Senna (from Arabic sanā) the sennas, is a large Genus of around 250 Species of Flowering plants in the Aloe vera, also known as the Medicinal Aloe, is a species of Succulent plant that probably originated in northern Africa. Castor oil is a Vegetable oil obtained from the Castor bean (technically castor seed as the castor plant Ricinus communis, is not a member of Bisacodyl ( INN) is a stimulant Laxative drug It is typically prescribed for relief of Constipation and for the management of neurogenic bowel dysfunction A suppository is a drug delivery system that is inserted either into the Rectum (rectal suppository Vagina (vaginal suppository or Urethra (urethral In the Esophagus After food is chewed into a bolus it is swallowed to move it into the esophagus Long term use can lead to 'cathartic colon'. [7] Stimulant laxatives act on the intestinal mucosa, or nerve plexus; they also alter water and electrolyte secretion. The mucous membranes (or mucosae; singular mucosa) are linings of mostly endodermal origin covered in Epithelium, which are involved in An electrolyte is any substance containing free Ions that behaves as an electrically conductive medium They are the most severe among laxatives and should be used only in extreme conditions. Castor oil may be preferred when more complete evacuation is required. Castor oil is a Vegetable oil obtained from the Castor bean (technically castor seed as the castor plant Ricinus communis, is not a member of

Castor oil

Castor oil acts directly on intestinal mucosa or nerve plexus and alters water and electrolyte secretion. Castor oil is a Vegetable oil obtained from the Castor bean (technically castor seed as the castor plant Ricinus communis, is not a member of It is converted into ricinoleic acid (the active component) in the gut.

Serotonin agonist

Tegaserod is a motility stimulant that works through activation of 5-HT4 receptors of the enteric nervous system in the gastrointestinal tract. Tegaserod is a 5-HT 4 Agonist manufactured by Novartis and used for the management of Irritable bowel syndrome and Constipation Serotonin (ˌsɛrəˈtoʊnən ( 5-hydroxytryptamine, or 5-HT) is a Monoamine Neurotransmitter synthesized in serotonergic Neurons The enteric nervous system ( ENS) is a subdivision of the Peripheral Nervous System, that directly controls the Gastrointestinal system. However caution must be taken due to potentially harmful cardiovascular side-effects.

Uses

Bowel Prep. Chronic constipation. Chronic immobility.

Problems with use

Laxative Abuse

Laxative abuse is potentially serious since it can lead to intestinal paralysis, Irritable Bowel Syndrome (IBS), pancreatitis, renal failure,[8][9] and other problems. In Anatomy, the intestine is the segment of the alimentary canal extending from the Stomach to the Anus and in humans and other mammals consists In Gastroenterology, irritable bowel syndrome ( IBS) is a Functional bowel disorder characterized by mild to severe Abdominal pain, discomfort Pancreatitis is the Inflammation of the Pancreas. See also Acute pancreatitis and Chronic pancreatitis for more details Renal failure or kidney

Laxative gut

Physicians generally warn against the chronic use of stimulant laxatives due to concern that chronic use causes the colonic tissues to get worn out over time and not be able to expel feces due to long term overstimulation. The evidence for this was never too strong, and it was always unclear whether the elongated and poorly moving colon of a patient with chronic constipation was a result of or was just a cause for patients' use of stimulant laxatives. A common finding in patients who have used stimulant laxatives is a brown pigment deposited in the intestinal tissue, known as Melanosis coli. Melanosis coli is a disorder of pigmentation of the wall of the colon, identified at the time of Colonoscopy.

Eating Disorders

Laxatives are often used by people with an eating disorder. In many cases of bulimia nervosa the patient will abuse laxatives in an attempt to purge themselves of food in the intestines before it becomes digested. Bulimia nervosa is an Eating disorder characterized by recurrent Binge eating, followed by compensatory behaviors referred to as "purging" Frequently, patients with eating disorders had chronic digestive problems in childhood and found laxatives an effective treatment. The laxative use later may substitute of more appropriate treatment such as a better diet. Treatment of patients with eating disorders and gastrointestinal illnesses can be challenging.

References

  1. ^ Chang L, Toner B, Fukudo S, Guthrie E, Locke G, Norton N, Sperber A (2006). "Gender, age, society, culture, and the patient's perspective in the functional gastrointestinal disorders". Gastroenterology 130 (5): 1435-46. doi:10.1053/j.gastro.2005.09.071. A digital object identifier ( DOI) is a permanent identifier given to an Electronic document. PMID 16678557.  
  2. ^ Di Palma JA, Cleveland MV, McGowan J, Herrera JL (2007). "A randomized, multicenter comparison of polyethylene glycol laxative and tegaserod in treatment of patients with chronic constipation". Am. J. Gastroenterol. 102 (9): 1964–71. doi:10.1111/j.1572-0241.2007.01365.x. A digital object identifier ( DOI) is a permanent identifier given to an Electronic document. PMID 17573794.  
  3. ^ Attar A, Lémann M, Ferguson A, Halphen M, Boutron M, Flourié B, Alix E, Salmeron M, Guillemot F, Chaussade S, Ménard A, Moreau J, Naudin G, Barthet M (1999). "Comparison of a low dose polyethylene glycol electrolyte solution with lactulose for treatment of chronic constipation. ". Gut 44 (2): 226-30. PMID 9895382.  
  4. ^ Dipalma JA, Cleveland MV, McGowan J, Herrera JL (2007). "A randomized, multicenter, placebo-controlled trial of polyethylene glycol laxative for chronic treatment of chronic constipation". Am. J. Gastroenterol. 102 (7): 1436-41. doi:10.1111/j.1572-0241.2007.01199.x. A digital object identifier ( DOI) is a permanent identifier given to an Electronic document. PMID 17403074.  
  5. ^ Lederle F, Busch D, Mattox K, West M, Aske D (1990). "Cost-effective treatment of constipation in the elderly: a randomized double-blind comparison of sorbitol and lactulose. ". Am J Med 89 (5): 597-601. doi:10.1016/0002-9343(90)90177-F. A digital object identifier ( DOI) is a permanent identifier given to an Electronic document. PMID 2122724.  
  6. ^ BestBETs: Is polyethylene glycol safe and effective for chro.... Retrieved on 2007-09-06. Year 2007 ( MMVII) was a Common year starting on Monday of the Gregorian calendar in the 21st century. Events 3114 BC - According to the Proleptic Julian calendar the current era in the Maya Long Count Calendar started
  7. ^ Joo J, Ehrenpreis E, Gonzalez L, Kaye M, Breno S, Wexner S, Zaitman D, Secrest K (1998). "Alterations in colonic anatomy induced by chronic stimulant laxatives: the cathartic colon revisited. ". J Clin Gastroenterol 26 (4): 283-6. doi:10.1097/00004836-199806000-00014. A digital object identifier ( DOI) is a permanent identifier given to an Electronic document. PMID 9649012.  
  8. ^ Copeland P (1994). "Renal failure associated with laxative abuse". Psychother Psychosom 62 (3-4): 200-2. PMID 7531354.  
  9. ^ Wright L, DuVal J (1987). "Renal injury associated with laxative abuse". South Med J 80 (10): 1304-6. doi:10.1097/00007611-198710000-00024. A digital object identifier ( DOI) is a permanent identifier given to an Electronic document. PMID 3660046.  

See also

External links

Dictionary

laxative

-adjective

  1. Having the effect of moving the bowels, or aiding digestion and preventing constipation.

-noun

  1. Any substance, such as a food or in the form of a medicine which has a laxative effect.
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