Makindo Medical Notes

💡 Always confirm the patient is constipated (and not obstructed). Check for red flags: bowel obstruction, acute abdomen, IBD flare. Identify and treat underlying causes (e.g. drugs, immobility, dehydration, low fibre).

📘 About

• Check BNF or local guidelines for up-to-date prescribing advice.
• Laxatives fall into 3 main groups: bulk-forming, stimulant, and osmotic. Often used in combination.
• Always review concurrent drugs (opioids, anticholinergics, iron, calcium) as potential causes.

📊 Laxative Classes

💡 Clinical Pearls

• Opioid-induced constipation: start stimulant (senna/bisacodyl) ± osmotic (lactulose/macrogol). Avoid bulk-forming.
• Immobile/frail patients: bulk-forming agents often poorly tolerated.
• Enemas/suppositories: useful for faecal impaction or if rapid relief needed.
• Encourage hydration, mobility, and dietary fibre alongside pharmacological therapy.

🚫 Red Flags – Do NOT start laxatives without review if:

• Severe abdominal pain, distension, or vomiting.
• Suspected bowel obstruction.
• Recent onset constipation in elderly without clear cause.
• History of IBD with flare symptoms.

📚 References

• BNF – Laxatives
• NICE CKS – Constipation in adults