Constipation Management: Appropriate use of laxatives

For many children with special health care needs, problems with constipation require long-term use of laxative medications and specialized bowel programs, in addition to nutrition intervention. Some medications that are commonly used are reviewed below.

Irritant/stimulants
Bulk-producing or bulk-forming
Lubricants
Surfactants or stool softeners
Osmotic
Miscellaneous

Irritant/Stimulants

Examples cascara, danthron, senna, phenolphthalein, casanthranol; bisacodyl tablets; bisacodyl suppository, castor oil

Brand name or common name cascara, Senokot , Ex-Lax ; Dulcolax , Fletcher’s, Castoria

Action Direct action in intestinal mucosa; stimulates myenteric plexus; alters water and electrolytes

Comments

• Cascara and senna may cause yellow-brown urine; alkaline urine may turn pink-red or violet red
• Bile must be present for phenolphthalein to have effect
• Do not give bisacodyl tablets within 1 hour of antacids or milk products

Bulk-Producing or Bulk-Forming

Examples methylcellulose, psyllium, poly carbophil

Brand name or common name Citrucel, Hyrocil, Metamucil, Chroulac, Malt Supex

Action Holds water in stool; mechanical distension; malt soup extract reduces fecal pH

Comments

• Do not give with salicylates, digitalis, or cardiac glycosides
• May cause obstruction if passage is stopped

Lubricants

Examples mineral oil, oil enema

Action Lubricates intestine, retards colonic absorption of fecal water; softens stool and decreases water absorption

Comments

• Not recommended for children under 1 year of age or children who are at risk for aspiration

Surfactants or Stool Softeners

Examples docusate sodium (Colace; Doss)

Action Detergent activity; allows stool to retain water, making stool softer and easier to pass

Comments

• Beneficial when feces are hard or dry, or in anorectal conditions where passage of a firm stool is painful
• Do not give if mineral oil given

Osmotic

Examples Lactulose, sorbitol, barley malt extract, magnesium hydroxide, magnesium citrate; osmotic enemas

Brand name or common name Lactulose, Cephulac, Chronulac, Epsom salts, Milk of magnesia, Fleets enema

Action Attract/retain water in the intestinal lumen, increasing intraluminal pressure

Comments

• May alter fluid and electrolyte balance

Miscellaneous

Glycerin

Action Local irritation caused by sodium stearate in preparation; hyperosmotic action

Polyethylene glycol (Miralax)

Action Osmotic agent, causes stool to retain water