Straight Talk About Laxatives

Lots of parents have questions about laxatives. This video gives information about the different types, how they work, and why your child might need one kind or another.

A full transcript of the video appears below.

Hello, my name is Kelly Savitri and I’m a nurse with the Vermont Continence Project. In this video, I will attempt to address many of the questions and concerns that families have expressed about laxative use during constipation treatment. As always, I want to remind you that this information is for educational purposes only. Nothing in this presentation should be taken as medical advice, and we always encourage you to work closely with your child’s healthcare provider to develop and implement any kind of treatment plan.

So why do we need to use laxatives? Sometimes families would rather try focusing on diet, hydration, and exercise before using medication to treat constipation. The reason that this is not effective is because of the power of withholding and the long time it takes to heal chronic constipation.

Remember the constipation cycle from previous videos. Once a child has experienced painful bowel movements and developed a negative association with pooping, they try to avoid pooping by withholding. Great nutrition, hydration, and exercise is not enough to overcome this behavior pattern. To break that painful association we need to clear the impaction and keep bowel movements soft and painless long enough for a child’s body to heal and long enough for them to learn the necessary skills to recognize and respond to their body’s signals. Laxatives are the most effective way to do this.

There are several kinds of laxatives that all work a bit differently. Sometimes a single type is prescribed and sometimes more than one are prescribed in combination. We have found that treatment plans are often most successful if a child’s caregivers understand the reason behind each prescription and know that the different types of laxatives are not interchangeable because they work in different ways.

The three types that I will discuss today are stool softeners, stimulant laxatives, and bulk-forming laxatives. The most commonly used type of laxatives are stool softeners. Remember that stool enters the large intestine as liquid and then becomes more solid as it travels to the rectum. Most stool softeners work by keeping more water in the stool, preventing it from drying out and getting hard. They do this by staying in the digestive tract and drawing water to them, so, unlike many medications, they don’t get absorbed into the bloodstream. Other stool softeners work by lubricating the colon, allowing stool to pass through with less resistance. Stool softeners are considered very safe. Some examples include polyethylene glycol, most commonly known as MiraLAX, magnesium citrate, glycerin, and lactulose.

PEG is usually known by the brand name MiraLAX. It is the medication that we most frequently see prescribed for both acute constipation and maintenance bowel treatment. This is because it is very safe and effective. Here are some helpful tips about this medication if it is part of your child’s treatment plan. The first is to know that it can be mixed into any kind of liquid or soft food, hot or cold. This can be juice, milk, smoothies, yogurt, applesauce, pudding, really anything that the powder can dissolve into.

Sometimes parents report that their child refuses to drink anything that they suspect of containing medicine, so we usually try to identify a few different creative options and encourage parents to rotate through them so that it’s not in the same thing every day. Also, it becomes less noticeable if you give it time to dissolve. You can mix it up hours in advance and just keep it in the refrigerator. Also, children tend to be more resistant if we make a big deal about them having to eat or drink something. Try to be casual about it.

Know that PEG is very flexible when it comes to the dose and time. Since this medication is only working in the digestive tract and doesn’t get absorbed systemically, it’s okay if they don’t take the whole dose all at once. For example, if you put the whole dose in yogurt and they only eat half of it, just try to put half a dose in something else later. It’s fine to put the whole dose in a water bottle that they slowly drink throughout the day, or if they only drink half their juice in the morning, just put it in the fridge and give it to them when they come home from school that afternoon. The goal is to get the whole dose in them by the end of the day, but you can be really creative about how that happens.

In our previous video, “Elimination Basics,” I described how chronic constipation causes the muscles of the large intestine to become stretched out and weak. Sometimes these weak muscles can’t effectively push poop out, resulting in incomplete bowel movements. Stimulant laxatives work directly on these muscles, stimulating them to contract and push poop along the digestive tract. They make up for some of that weakness and help a child’s body achieve a full, complete bowel movement. With consistent bowel maintenance treatment, those overstretched muscles will eventually become strong again, but a stimulant laxative may be a helpful support during the healing process.

The muscle contractions caused by stimulant laxatives can create mild to moderate cramping sensations. This can be especially uncomfortable if there’s a hard, dry stool blocking the colon, so stimulant laxatives are often used in combination with stool softeners to ease the passage of an impaction. Stimulant laxatives are used cautiously, because a person can develop a tolerance to them over time and they start to require a higher dose to achieve the same effect. This is part of why it is so important to have a provider supervising the use of this type of medication.

There are several examples of stimulant laxatives. The most commonly used is senna. Senna is a plant, so it is often found in herbal supplements, but it is also prescribed as a pharmaceutical medication and is the active ingredient in Ex-lax.

The last type of laxatives are called bulk-forming. These are essentially a kind of fiber supplement that can come from a natural or synthetic source. These are similar to stool softeners in that they attract water into the stool, but they also make the stool larger. This type of laxative can be part of an ongoing maintenance plan, but it is not appropriate for acute phase treatment. Bulk-forming laxatives will not help to move an impaction, and using them when an impaction is present can cause an increase in discomfort, gas, and bloating. Some examples of this type are psyllium, methylcellulose, and polycarbophil.

Some families are hesitant to use pharmaceutical medication and would rather try a more natural approach. This is totally understandable and it is possible, but there are some very important things to consider. Most importantly, we recommend working with a trained professional, such as a naturopathic doctor or clinical herbalist. Keep in mind that even these professionals may not be familiar with disimpaction, so we still recommend collaborating with your primary care provider.

There are many products marketed on the internet to treat constipation, and even some specifically for children. Unfortunately, their quality can be inconsistent and sometimes their actual ingredients are not what they say they are. A trained professional can help you identify brands that you can trust. Also, some herbs like senna act as stimulant laxatives, which we know can cause a tolerance to develop, and some products contain fiber ingredients, which can be bulk-forming and are not appropriate for acute treatment. Remember, natural does not necessarily mean gentle. Some supplements contain very powerful stimulant laxatives and should be used cautiously.

Sometimes when families are hesitant about pharmaceutical laxatives, we encourage them to consider a hybrid approach. This means following the disimpaction or cleanout protocol from your healthcare provider for the acute phase of treatment, and then bringing in a complementary health professional, such as a naturopath or herbalist, to help you develop an ongoing maintenance plan that focuses on nutrition, hydration, and exercise as well as trusted supplements that support complete and regular stooling. Please watch our video “Nutrition in Acute Phase Constipation Management” for more details about these interventions.

Thank you for taking the time to watch this. The information contained in this video is for informational purposes only. It is not a substitute for professional health or medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider.