30.3 Laxatives and Stool Softeners
4 min read•june 18, 2024
and are crucial for managing . They work in different ways, from bulking up stool to drawing water into the intestines. Understanding how each type functions helps choose the right one for specific needs.
Nurses play a key role in administering these medications safely. They must assess patients, monitor for side effects, and educate on proper use. This includes teaching about hydration, diet, and lifestyle changes to support digestive health.
Types and Mechanisms of Laxatives and Stool Softeners
Laxatives and stool softeners
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- Increase fecal mass by absorbing water and stimulate through increased intestinal pressure
- (Metamucil), (Citrucel), polycarbophil () act as soluble fibers that form a gel-like substance in the intestines
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- Draw water into the intestines by creating an osmotic gradient to soften stool and increase motility through increased intestinal pressure
- (Milk of Magnesia), (), lactulose (Kristalose) are hyperosmolar agents that retain water in the colon
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- Increase intestinal motility by stimulating the myenteric plexus and secretion of water and electrolytes into the intestinal lumen
- (), (), stimulate and reduce water absorption in the colon
- Emollient laxatives ()
- Soften stool by increasing water penetration into the stool and decreasing surface tension of the stool
- () is a surfactant that allows water and fats to penetrate the stool more easily
Mechanisms, indications, and side effects
- laxatives
- Mechanism: absorb water to increase fecal mass and stimulate peristalsis through increased intestinal pressure
- Indications: chronic , irritable bowel syndrome, diverticular disease help regulate bowel movements and prevent straining
- Side effects: , , abdominal discomfort may occur due to increased gas production from bacterial fermentation
- Osmotic laxatives
- Mechanism: create an osmotic gradient to draw water into the intestines, softening stool and increasing motility through increased intestinal pressure
- Indications: acute and chronic constipation, preparation for bowel procedures (colonoscopy) help clear the bowels
- Side effects: (hypermagnesemia with magnesium-based laxatives), , abdominal cramping can result from excessive fluid loss
- Stimulant laxatives
- Mechanism: stimulate intestinal motility by activating the myenteric plexus and secretion of water and electrolytes into the intestinal lumen
- Indications: acute constipation, preparation for bowel procedures (surgery) provide rapid relief of constipation
- Side effects: abdominal cramping, , electrolyte imbalances, melanosis coli (darkening of the colon mucosa with long-term use) can occur due to overstimulation
- Emollient laxatives (stool softeners)
- Mechanism: decrease surface tension of the stool and allow water to penetrate more easily, softening the stool
- Indications: prevention and treatment of constipation, , help reduce straining during bowel movements
- Side effects: abdominal cramping, diarrhea, electrolyte imbalances (rare) may occur with excessive use
Nursing Considerations and Patient Education
Nursing considerations
- Assess patient's bowel habits, medical history (obstruction, impaction, inflammatory bowel disease), and current medications (opioids, anticholinergics) before administering to ensure appropriate selection and safety
- Monitor fluid and , especially with osmotic and stimulant laxatives, to prevent dehydration and electrolyte abnormalities
- Encourage adequate fluid intake (8-10 glasses per day) to prevent dehydration and enhance laxative effectiveness by softening stool
- Provide privacy and ensure easy access to bathroom facilities to promote patient comfort and prevent accidents
- Monitor for adverse effects (, diarrhea, electrolyte imbalances) and report to the healthcare provider if necessary to adjust therapy
- Educate patients on proper use, potential side effects, and when to seek medical attention to ensure safe and effective use
Patient education plan
- Explain the purpose and mechanism of action of the prescribed laxative or stool softener to promote understanding and adherence
- Provide clear instructions on dosage, frequency (daily, as needed), and duration of use (short-term, long-term) to ensure proper administration
- Emphasize the importance of staying hydrated and drinking adequate fluids (water, clear liquids) to prevent dehydration and enhance laxative effectiveness
- Encourage a balanced diet rich in fiber (whole grains, legumes), fruits (prunes, apples), and vegetables (broccoli, carrots) to promote regular bowel movements and overall digestive health
- Advise patients to report any adverse effects (severe abdominal pain, bloody stools) or persistent constipation (no bowel movement for 3 days) to their healthcare provider for prompt evaluation and management
- Caution against long-term use of stimulant laxatives due to potential dependence and adverse effects (electrolyte imbalances, melanosis coli) and recommend gradual tapering under medical supervision
- Recommend lifestyle modifications, such as regular exercise (walking, yoga) and establishing a consistent (going to the bathroom at the same time each day) to promote regular bowel movements
- Inform patients about non-pharmacological interventions, such as fiber supplementation (bran, psyllium) and abdominal massage (gentle circular motions) to enhance the effectiveness of laxatives and stool softeners
Key Terms to Review (77)
Abdominal Cramps: Abdominal cramps refer to the sudden, involuntary, and painful contractions of the muscles in the abdomen. These cramps can range from mild discomfort to severe, debilitating pain and are often associated with various gastrointestinal conditions or the use of certain medications, such as laxatives and stool softeners.
Abdominal Pain: Abdominal pain refers to any discomfort or pain experienced in the abdominal region, which encompasses the area between the chest and the pelvis. This symptom can be associated with various gastrointestinal and other medical conditions, and understanding its context is crucial in the management of conditions related to laxatives, stool softeners, histamine blockers, proton-pump inhibitors, pepsin inhibitors, and prostaglandin analogues.
Anal Fissures: An anal fissure is a small, painful tear in the skin of the anus that can cause discomfort, bleeding, and difficulty with bowel movements. Anal fissures are commonly associated with constipation and the passage of hard, dry stools, which can irritate and damage the sensitive skin around the anus.
Antidiarrheal: Antidiarrheals are medications used to alleviate or stop diarrhea by slowing down gut movement or absorbing excess fluid in the intestines. These drugs help restore normal bowel function and prevent dehydration.
Arlex: Arlex is a combination medication used as a laxative to treat constipation. It typically contains senna and docusate, which work together to stimulate bowel movements and soften stools.
Bisacodyl: Bisacodyl is a stimulant laxative medication that works by increasing the contractions of the intestines, leading to the passage of stool. It is commonly used to treat constipation and to prepare the bowel for medical procedures.
Bisacodyl Pr: Bisacodyl is a stimulant laxative used to treat constipation by stimulating bowel movements. It is commonly administered orally or rectally.
Bloating: Bloating refers to a feeling of fullness, tightness, or swelling in the abdomen, often accompanied by gas or discomfort. It is a common symptom that can be associated with various gastrointestinal conditions and can also occur as a side effect of certain medications.
Bowel Motility: Bowel motility refers to the rhythmic contractions and relaxations of the intestinal muscles that facilitate the movement of digested food and waste through the digestive tract. This process is crucial for maintaining regular bowel function and overall gastrointestinal health.
Bowel Movement Consistency: Bowel movement consistency refers to the texture, shape, and ease of passage of an individual's stool. It is an important indicator of digestive health and can be influenced by various factors, including diet, hydration, and the use of laxatives or stool softeners.
Bowel Movement Frequency: Bowel movement frequency refers to the regularity and number of times an individual has a bowel movement within a given timeframe. It is an important consideration in the context of laxatives and stool softeners, as these medications can directly impact the frequency and ease of bowel movements.
Bowel Obstruction: Bowel obstruction is a condition in which the normal passage of contents through the intestines is partially or completely blocked, preventing the normal flow of digested food, fluids, and gas. This can occur in the small or large intestine and is a serious medical emergency that requires prompt treatment.
Bowel Preparation: Bowel preparation refers to the process of cleansing the gastrointestinal tract, typically in preparation for a medical procedure such as a colonoscopy or surgery. It involves the use of laxatives, enemas, or other methods to empty the bowels and ensure a clear view or access during the procedure.
Bowel Routine: A bowel routine refers to the regular pattern or schedule of bowel movements that an individual typically experiences. It is an important aspect of overall digestive health and can be influenced by various factors, including diet, physical activity, and medication use.
Bulk-forming: Bulk-forming laxatives are substances that absorb water in the intestines, increasing stool bulk and promoting bowel movements. They are often used to treat constipation and maintain regularity.
Bulk-Forming Laxatives: Bulk-forming laxatives are a class of laxatives that work by increasing the volume and water content of stool, making it easier to pass. They are a gentle and natural way to relieve constipation and promote regular bowel movements. These laxatives are particularly useful for maintaining long-term digestive health.
Calcium polycarbophil: Calcium polycarbophil is a bulk-forming laxative used to treat constipation. It works by absorbing water into the stool, making it easier to pass.
Castor oil: Castor oil is a stimulant laxative derived from the seeds of the Ricinus communis plant. It is used to relieve constipation by increasing bowel movements.
Citroma: Citroma is a brand name for magnesium citrate, a saline laxative used to treat constipation by attracting water into the intestines to induce bowel movements. It is often used prior to surgical or diagnostic procedures involving the colon.
Citrucil: Citrucil is a bulk-forming laxative that helps relieve constipation by increasing the water content and volume of stools, making them easier to pass. It contains methylcellulose, a non-fermentable fiber that does not cause gas.
Colace: Colace is a stool softener used to treat constipation by making bowel movements easier. It works by increasing the amount of water absorbed by the stool, making it softer.
Colorectal Cancer: Colorectal cancer is a type of cancer that originates in the colon or rectum, which are part of the large intestine. It is a significant health concern that can be influenced by various factors, including immunosuppression, biologics, monoclonal antibodies, and biosimilar drugs, as well as the use of laxatives and stool softeners.
Constipation: Constipation is a condition characterized by infrequent bowel movements or difficulty in passing stools. It can be a common side effect of opioid medications.
Constipation: Constipation is a common gastrointestinal condition characterized by infrequent or difficult bowel movements, often accompanied by hard, dry stool. This term is particularly relevant in the context of various medication classes, as certain drugs can either cause or alleviate constipation as a side effect or therapeutic effect.
Correctol: Correctol is an over-the-counter stimulant laxative used to treat constipation. It works by stimulating bowel movements to help evacuate the bowels.
Decreased Urine Output: Decreased urine output, also known as oliguria, refers to a reduction in the volume of urine produced by the kidneys. This condition is often associated with various health issues, including those related to laxatives and stool softeners, as the kidneys play a crucial role in fluid balance and waste elimination.
Dehydration: Dehydration refers to the condition where the body loses more fluid than it takes in, resulting in an imbalance of water and electrolytes. This term is particularly relevant in the context of osmolality, cardiac emergencies and shock, laxatives and stool softeners, diuretics, and osmotic diuretics, as these topics all involve the regulation and imbalance of bodily fluids.
Diarrhea: Diarrhea is the condition characterized by frequent, loose, and watery bowel movements. It is a common gastrointestinal symptom that can be caused by a variety of factors and can have implications across different medical disciplines, including Alzheimer's drugs, mood stabilizers, expectorants, laxatives, histamine blockers, and prostaglandin analogues.
Docusate calcium: Docusate calcium is a surfactant stool softener used to relieve constipation by increasing the amount of water the stool absorbs in the gut, making it easier to pass. It is commonly prescribed for patients with conditions that require avoiding straining during bowel movements.
Docusate sodium: Docusate sodium is a stool softener used to treat constipation by increasing the amount of water the stool absorbs in the gut, making it softer and easier to pass. It is commonly used as part of a bowel management program.
Docusate Sodium: Docusate sodium is a stool softener that works by increasing the amount of water in the intestines, making stools softer and easier to pass. It is commonly used to treat and prevent constipation, as well as to prepare the bowel for medical procedures.
Dry Mouth: Dry mouth, also known as xerostomia, is a condition characterized by a decrease in the production and flow of saliva. This can have significant impacts on various aspects of health and daily functioning.
Dulcolax: Dulcolax is a brand name for bisacodyl, a stimulant laxative used to treat constipation. It works by stimulating bowel movements and increasing fluid in the intestines.
Electrolyte balance: Electrolyte balance is the regulation of electrolyte levels in the body to maintain homeostasis. It involves maintaining optimal concentrations of ions such as sodium, potassium, and calcium.
Electrolyte Balance: Electrolyte balance refers to the proper regulation and maintenance of various charged minerals, such as sodium, potassium, calcium, and chloride, within the body's fluids. This delicate balance is essential for various physiological processes, including nerve and muscle function, fluid regulation, and pH balance.
Electrolyte Imbalances: Electrolyte imbalances refer to abnormal levels of essential minerals, such as sodium, potassium, calcium, and magnesium, in the body. These imbalances can have significant impacts on various physiological processes, including cardiac function, fluid balance, and nerve and muscle function. Understanding electrolyte imbalances is crucial in the context of Class III potassium channel blockers, sodium-glucose cotransporter 2 inhibitors (SGLT2Is), and laxatives and stool softeners, as these medications can directly or indirectly influence electrolyte levels.
Emulsoil: Emulsoil is a type of stool softener used to treat constipation by making stools easier to pass. It works by increasing the amount of water the stool absorbs in the gut, making it softer and easier to move.
Enema: An enema is a procedure in which liquid or gas is injected into the rectum to stimulate a bowel movement or for other medical purposes. It is commonly used in the context of laxatives and stool softeners to help relieve constipation or prepare the bowel for medical procedures.
Fecal Impaction: Fecal impaction is a severe form of constipation where a large, hardened mass of stool becomes stuck in the rectum or lower colon, preventing the passage of additional stool. This condition can occur when stool remains in the intestines for too long, leading to dehydration and compaction of the fecal matter.
Fiber Intake: Fiber intake refers to the amount of dietary fiber consumed, which is the indigestible part of plant-based foods that plays a crucial role in maintaining digestive health and promoting regular bowel movements. Fiber intake is an important consideration in the context of laxatives and stool softeners, as it can influence the effectiveness and need for these gastrointestinal medications.
Fiberall: Fiberall is a bulk-forming laxative that increases stool mass and water content, aiding in bowel movements. It is commonly used to treat constipation.
FiberCon: FiberCon is a bulk-forming laxative used to treat constipation by absorbing water into the stool, making it easier to pass. It contains calcium polycarbophil as its active ingredient.
Flatulence: Flatulence, commonly known as gas or passing wind, refers to the accumulation and expulsion of gas from the digestive system. This term is particularly relevant in the context of various pharmaceutical agents that can influence the production and expulsion of gas within the body.
Fluid balance: Fluid balance refers to the maintenance of the proper amount and distribution of fluids in the body. It is crucial for normal physiological functions and overall homeostasis.
Fluid Balance: Fluid balance refers to the equilibrium between the amount of fluids entering and leaving the body, ensuring proper hydration and maintaining optimal physiological functions. This term is particularly relevant in the context of osmolality, intravenous fluid therapy, total parenteral nutrition, blood products, diuretics, laxatives, and stool softeners.
Hemorrhoids: Hemorrhoids are swollen veins in the lower rectum and anus. They can cause discomfort, bleeding, and in severe cases, prolapse. Hemorrhoids are a common condition that can be exacerbated by constipation and straining during bowel movements, which is why they are relevant to the topics of laxatives and stool softeners.
Intestinal Microbiome: The intestinal microbiome refers to the diverse community of microorganisms, primarily bacteria, that reside within the human gastrointestinal tract. This complex ecosystem plays a crucial role in various physiological processes, including nutrient absorption, immune system regulation, and the maintenance of overall gut health.
Irregular Heartbeat: An irregular heartbeat, also known as arrhythmia, is a condition where the heart's normal rhythmic contractions are disrupted, leading to an abnormal heart rate or pattern. This can affect the heart's ability to effectively pump blood throughout the body.
Konysl: Konysl is a medication used to treat constipation by acting as a stool softener. It is often prescribed for patients who need to avoid straining during bowel movements.
Laxative Dependence: Laxative dependence is a condition where an individual becomes reliant on the use of laxatives to have regular bowel movements, often leading to a cycle of overuse and withdrawal symptoms. This term is particularly relevant in the context of the topics 30.3 Laxatives and Stool Softeners, as it highlights the potential for misuse and addiction associated with these types of medications.
Laxatives: Laxatives are substances that promote bowel movements and relieve constipation. They work by increasing stool frequency, softening the stool, or stimulating intestinal motility.
Linaclotide: Linaclotide is a guanylate cyclase-C agonist used to treat irritable bowel syndrome with constipation (IBS-C) and chronic idiopathic constipation (CIC). It works by increasing the secretion of chloride and water in the intestines, which helps ease bowel movements.
Linzess: Linzess is a medication used to treat irritable bowel syndrome with constipation (IBS-C) and chronic idiopathic constipation (CIC). It works by increasing the secretion of chloride and water in the intestines, helping to soften stools and promote bowel movements.
Magnesium citrate: Magnesium citrate is a saline laxative used to treat occasional constipation. It works by attracting water into the intestines, which helps to induce bowel movements.
Magnesium Hydroxide: Magnesium hydroxide is a chemical compound with the formula Mg(OH)2. It is a white, odorless, and tasteless powder that is commonly used as a laxative and antacid medication.
Methycellulose: Methycellulose is a bulk-forming laxative that absorbs water into the stool, making it easier to pass. It is often used to treat constipation and maintain regular bowel movements.
Methylcellulose: Methylcellulose is a water-soluble, nonionic cellulose ether that is commonly used as a laxative and stool softener. It is derived from cellulose, a naturally occurring polysaccharide found in plant cell walls, through the chemical process of methylation.
Mineral Oil: Mineral oil is a type of laxative used to treat constipation by lubricating the stool and intestines, making it easier to pass. It is generally taken orally or rectally.
Miralax: Miralax is a brand name for polyethylene glycol 3350, an osmotic laxative used to treat occasional constipation. It works by retaining water in the stool, increasing stool frequency and improving bowel movements.
Muscle Cramps: Muscle cramps are sudden, involuntary, and painful contractions of a muscle or group of muscles. They are a common occurrence and can affect various muscle groups in the body, often disrupting daily activities and causing discomfort.
Osmotic Laxatives: Osmotic laxatives are a class of medications that work by drawing water into the intestines, softening stool and stimulating bowel movements. They are commonly used to treat constipation by increasing the amount of water in the digestive tract, which helps to loosen and pass stools more easily.
Peristalsis: Peristalsis is the coordinated, rhythmic contractions of smooth muscles that move food through the gastrointestinal tract. It ensures the progressive movement of contents from the esophagus to the rectum.
Peristalsis: Peristalsis is the rhythmic, wave-like contraction of smooth muscles that propels food and other materials through the digestive tract. This coordinated movement is essential for the proper functioning of the gastrointestinal system and is influenced by the nervous system.
Polyethylene glycol: Polyethylene glycol (PEG) is a laxative used to treat occasional constipation by drawing water into the bowel, which helps soften stools and stimulate bowel movements. It is often used as a solution mixed with water or other liquids.
Polyethylene Glycol: Polyethylene glycol (PEG) is a water-soluble polymer that is commonly used as a laxative and stool softener. It works by drawing water into the intestines, which helps to soften stool and promote bowel movements.
Psyllium: Psyllium is a bulk-forming laxative derived from the husks of Plantago ovata seeds. It helps to increase stool bulk and promote bowel movements by absorbing water in the intestine.
Rectal Suppository: A rectal suppository is a solid dosage form that is inserted into the rectum. It is designed to melt at body temperature and release the active medication, which is then absorbed through the rectal mucosa. Rectal suppositories are commonly used for their local effects in the lower gastrointestinal tract or for systemic effects when other routes of administration are not feasible.
Saline laxatives: Saline laxatives are a type of laxative that work by drawing water into the intestines to soften stool and stimulate bowel movements. They are often used for rapid relief of constipation.
Senna: Senna is a natural laxative derived from the leaves and pods of the Senna plant. It stimulates bowel movements by irritating the lining of the bowel, which leads to a laxative effect.
Senokot: Senokot is a brand name for a natural, plant-derived laxative containing sennosides. It stimulates bowel movement by irritating the lining of the intestines.
Sorbitol: Sorbitol is a sugar alcohol used as a laxative to treat constipation. It works by drawing water into the intestines, which helps soften stools and stimulate bowel movements.
Stimulant Laxatives: Stimulant laxatives are a class of medications that work by stimulating the intestinal muscles to contract more forcefully, increasing the movement of contents through the digestive tract. They are used to treat constipation and promote regular bowel movements.
Stool softeners: Stool softeners are medications that help to soften the stool by drawing water into the bowel, making it easier to pass. They are commonly used to treat constipation and prevent straining during bowel movements.
Stool Softeners: Stool softeners, also known as emollient laxatives, are a type of medication that helps to soften and loosen stool, making it easier to pass. They work by increasing the amount of water and fat in the intestines, which helps to keep the stool soft and pliable.
Surfak: Surfak, also known as docusate calcium, is a stool softener used to treat constipation. It works by increasing the amount of water the stool absorbs in the gut, making it easier to pass.
Thirst: Thirst is the physiological need for water, triggered by the body's dehydration or electrolyte imbalance. It is a crucial mechanism that drives the consumption of fluids to maintain proper hydration and homeostasis within the body.
Weakness: Weakness refers to a lack of strength, energy, or effectiveness, which can impact various bodily functions and processes. In the context of laxatives and stool softeners, weakness is an important consideration as it can influence the effectiveness and safety of these medications.