What is a laxative?
The Oxford English Dictionary defines a laxative as “a medicine, food, or drink that makes someone empty their bowels easily”.
Used to relieve constipation, a laxative is generally regarded as something that stimulates the bowel, and is often perceived as being aggressive, with many people believing that taking a laxative is detrimental to the bowel and will ‘make it lazy.’
However, what is a person to do if they suffer with chronic constipation? If they’ve tried changing their diet, drinking more water, exercising, and used stress-relieving techniques, but still their bowels won’t move, then a laxative is often the only way to bring some relief. If they choose not to take a laxative, they face the pain of getting bunged up for days, sometimes weeks, which in turn increases the risk of ‘leaky’ gut, bowel infections, diverticulitis and bowel cancer.
Often people complain that they have taken laxatives, which work for a while, but then they stop working. Understanding a bit more about how laxatives work might help explain this. Let’s say someone is very anxious and they drink a cup of chamomile tea – this may soothe their anxiety, which will make them relax. A muscle can only work when it is in a relaxed state, and the bowel and gut are no different. So if the chamomile relaxes the bowel and stimulates a bowel movement, it can be described as having a laxative effect. Laxatives can be very effective at stimulating, relaxing, soothing or toning the bowel, helping to restore a natural rhythm.
Laxatives fall into the following broad categories:
- Bulking agents / Fibre
Stimulants work by triggering contractions in the bowel that push the stool along. The active ingredient in a stimulant laxative is often senna – a natural medicine containing sennosides that are derived from the leaves of the senna plant. Sennosides irritate the lining of the bowel causing a laxative effect. The bowel contracts to rid itself of the irritant. This is the most common perception of why laxatives are believed to make the bowel lazy, because the bowel is a muscle and if, like any other muscle in the body, it is not contracting and relaxing naturally, it is thought that it may become lazy and forget what it needs to do, thus it stops working unless laxatives are taken.
Bulking Agents / Fibre
Bulking agents work by increasing the amount of fibre in the gut and can help to tone the bowel as the bulk puts it under pressure to stimulate peristalsis (the natural relaxation and contraction of the bowel). These types of laxatives work in the same way as dietary fibre, increasing the bulk of stools by helping them retain fluid, encouraging the bowels to push the stools out. For this reason, adequate hydration must be maintained otherwise fibre can get stuck in the bowel, causing an obstruction. Also be careful if constipation is already in evidence when taking bulking laxatives as it can make the constipation worse. Psyllium husk and Fybogel are examples of bulking agents.
Emotional bowel spasticity is very common. In other words, if we are holding emotions in, this can cause the bowel to stop working and, if someone is anxious, the bowel can go into overdrive and empty too rapidly. Carminatives have a calming effect. They also aid expulsion of sometimes painful gas pockets and calm the bowel. Chamomile is an example of a carminitive.
Osmotic type laxatives draw water or retain water in the bowel to help keep faeces soft. Examples of osmotic type laxatives are:
- Lactulose and Glycerin: Lactulose is a synthetic sugar used to treat constipation. It is broken down in the large bowel into products that pull water out from the body and into the bowel. This water softens stools making it easier to eliminate them. Glycerin suppositories, made from glycerol, act as a mild irritant to help stimulate the anus to empty.
- Epsom Salts (magnesium sulphate): relaxes smooth muscle tissue in the bowel, promotes relaxation and vasodilation (dilates blood vessels).
- PEG (Polyethylene glycol 3350) contains hydrophilic molecules: works by keeping more water in the stool. Doesn’t affect nerves or muscles so doesn’t cause dependency. Laxido and Movicol are examples of PEG osmotic laxatives.
Mucilages work by adding mucous to the wall of the gut and bowel, effectively making it more slippery. They soothe the delicate gut membrane, reduce cramping and spasticity, and can help improve the symptoms of constipation. Slippery Elm and Marshmallow Root are examples of mucilages.
The name may sound contrary, suggesting that an anti-spasmodic can have a laxative effect, but it’s necessary to relax a tight tense bowel, allow peristalsis to function properly, and then allow the bowel to expel its contents. Peppermint, liquorice and fennel are examples of antispasmodics. These herbs also help break down and release painful trapped gas pockets.
Peristeen* and other home anal irrigation systems are useful for people suffering spinal injuries following neurological damage, including:
Motor Neurone Disease
Spinal cord injuries
Also for people on strong, opiod-based pain killing drugs
*For more information about the Peristeen home irrigation system, watch this helpful video.
Are laxatives safe?
Laxatives are safe as long as you know what you’re taking and why. Taking the right type of laxative appropriate to the condition is the key to success. It’s worth considering taking a laxative to help go to the toilet more regularly rather than ‘naturally’ only going once a week. Going once a week is not natural! Taking laxatives regularly at a low dose is better than waiting for a week and taking a big dose.
Taking a laxative to help you go to the toilet more regularly can have a positive effect on the bowel. It creates good bowel habits by working regularly and, in time, helps retrain the bowel to more regular habits. The bowel is a muscle and responds to exercise, making it more efficient and improving muscle tone as well as removing a build-up of toxic waste.
- Slimma-tea – usually contains senna, which has a laxative effect.
- OxyCleanse – various types but usually use magnesium as an active ingredient. Magnesium relaxes muscles so can relax the bowel. Sometimes it is mixed with psyllium husk so can produce large bowel movements.
- Dulcolax – stimulates nerve endings in the colon. Can cause cramps. Also can come in suppository form.
- Glycerine suppositories – gently stimulate the rectum. Some glycerine products contain other ingredients that can have an osmotic (drawing water into the bowel) effect.
- Colon cleansing tablets/capsules – there are a whole variety of these, though they often come in the form of an Aloe Vera cleanse. Many contain carminatives, but also contain stimulants such as liquorice and dandelion, cascara, senna, cape aloes, cayenne, goldenseal, and bulking agents such as psyllium.
If you are deficient in levels of magnesium because you’re not getting it from your food, magnesium glycinate are the best magnesium supplements, as they’re very well absorbed; magnesium citrate is good too for more stubborn constipation. Other cheaper forms of magnesium, such as magnesium oxide or magnesium chloride, are not well absorbed.
Likewise, Epsom salts baths (magnesium sulphate) can be useful. Pour a cupful into a bath of warm water and soak for 20 minutes. The magnesium will absorb through the pores of your skin and get into your bloodstream. You will also get the added relaxation benefits of magnesium, and if you have a bath before bed, you should sleep better. Don’t buy Epsom salts from chemists and supermarkets though – they are far too expensive. Buy organic Bittersaltz from here.
Magnesium-rich foods include:
- Dark leafy greens
- Dark chocolate
- Brown rice
- Fatty fish, such as salmon and mackerel
Other supplements to help improve transit time in the bowel
- Live bacteria cultures (aka probiotic capsules) – take one twice daily before meals. Recommended if you’ve noticed you’re getting more constipated after a course of antibiotics. This can often happen as the antibiotics kill off billions of beneficial gut bacteria needed to maintain normal transit time. Check out my Live Bacteria probiotic capsules here.
- Natural, plant-based digestive enzyme tablets. Take one tablet just before meals. To properly digest food, absorb nutrients and eliminate wastes, you need adequate amounts of stomach acid. Ageing and the taking of antacids reduce stomach acid and this can slow down transit time in the bowel. Check out my Digestive Enzyme tablets here.
Other herbal laxatives
There are so many that come under this section!
I recommend you only take them if you know what you are taking and why. The person prescribing needs to be trained and knowledgeable about the ingredients that they contain. Don’t be fooled into thinking that they are ‘just herbs’ so they are natural and therefore fine to take. Herbs are nature’s medicine and can be detrimental as well as efficacious.
Seek advice from a pharmacist or doctor before you take anything. Don’t just take things because they are there. They may not be appropriate for you and may interact with medications.
Don’t forget about colon hydrotherapy!
Last, but by no means least, this treatment has a wonderful laxative effect. It’s a safe, gentle, effective treatment to completely cleanse the large bowel. You can read more about this treatment here: www.colonic-association.org or www.rictat.org
Special thanks to Gillian Edwards, friend, fellow colon hydrotherapist and owner of Stourbridge Colonic Hydrotherapy Clinic, for helping me compile this blog on laxatives. For more information about Gillian, visit her website here: www.colonichealth.co.uk.