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Laxatives 💊
💡 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
| Class | Examples | Typical Dose | Contraindications | Common Side Effects |
|---|---|---|---|---|
| Bulk-forming | Fybogel (ispaghula husk) | 1 sachet in water BD PO | Swallowing difficulty, obstruction, faecal impaction | Flatulence, bloating, obstruction if not taken with water |
| Stimulant | Senna, Bisacodyl, Docusate, Glycerol supps |
Senna 2 tabs nocte PO
Bisacodyl 5–10 mg nocte PO Glycerol supp PRN Docusate 200 mg BD PO |
Obstruction, acute abdomen, active colitis | Diarrhoea, cramping, hypokalaemia |
| Osmotic | Lactulose, Movicol, Phosphate enema, Microlette |
Lactulose 10–15 mL BD PO
Movicol 1–3 sachets daily PO Phosphate enema PRN (max 2/24 h) |
Obstruction, colonic atony | Flatulence, bloating, nausea, local irritation (rectal) |
💡 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
| The content on this website is provided for educational and informational purposes only to support exam preparation (e.g., MLA, MRCP, USMLE) and learning. This is NOT medical advice, diagnosis, treatment, or professional guidance. It does not replace consultation with a qualified healthcare professional, official guidelines (e.g., NICE, GMC, BNF), or supervised clinical practice. Always verify information with current, authoritative sources. Makindo and its contributors accept no liability for any reliance on this content, including errors, omissions, or any resulting harm, loss, or consequences. By using this site, you agree to these terms. |
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