The Role of Osmotic Laxatives in Treating Constipation

For individuals dealing with constipation issues, can using an osmotic laxative help treat and prevent constipation?

Osmotic Laxative

Osmotic laxatives can help treat or prevent constipation by increasing the amount of water in the colon, softening stools, and making them easier to pass. Some osmotic laxatives are used for bowel preparation to help clear the colon before a colonoscopy. They are available over the counter and by prescription and can contain different active ingredients, including polyethylene glycol/PEG, lactulose, sorbitol, magnesium citrate, and magnesium hydroxides.

How They Work

Constipation occurs when stools are irregular and hard to pass, as they are usually hard and dry. An osmotic laxative helps relieve constipation by increasing the amount of fluid in the intestines. They pull water from the colon’s wall to the inside, softening stools and making them easier to pass. The term osmotic refers to the movement of fluids through a membrane with the concentration equal on both sides. In individuals with constipation problems, the concentration of water in the colon’s wall and the inside of the colon/lumen is balanced but insufficient to compensate for hard, dry stools. This is especially true of those who don’t drink enough water. Osmotic laxatives alter the balance with substances like salts, sugars, and other organic compounds to encourage water movement into the lumen.

How Are They Different?

Most laxatives are generally used for the treatment of occasional constipation. Osmotic laxatives work differently because they are used to prevent or treat chronic constipation. Other types of laxatives include:

Emollient

• These are made with a surfactant called docusate.
• Surfactants are substances that draw and spread fats and water.
• Docusate increases the passage of water and fats into stools to soften them.

Lubricant

• These are made with oily substances, like mineral oil, that help the stool slide through the intestine.

Stimulant

• These laxatives relieve constipation by causing the intestines to contract and push out the stools.

Osmotic Laxatives

The common osmotic laxatives are made with different active ingredients that include:

Polyethylene Glycol – PEG

• This organic compound is derived from petroleum and can be safely ingested to manage constipation.
• Available over the counter.
• These include Miralax and GlycoLax.

Lactulose

• This is a type of sugar that is not absorbed by the intestine.
• Instead, the sugar sits and ferments in the intestines, producing fatty acids that pull water into the lumen.
• Available by prescription, including Cephulac, Duphalac, Kristalose, and others.

Sorbitol

• This is also a non-absorbable sugar with activation similar to lactulose.
• Over-the-counter and prescription versions include Arlex and GeriCare.

Magnesium Citrate

• Magnesium citrate is magnesium in salt form combined with citric acid.
• The salts help pull water into the lumen.
• Over-the-counter versions include Citrate of Magnesia, Citroma, and LiquiPrep.

Magnesium Hydroxide

• This milder form of magnesium is sold under the brand Milk of Magnesia.
• Milk of Magnesia is also an antacid and is available over the counter.

Potential Side Effects

As with all medications, there can be potential side effects. Most are relatively mild and resolve independently within a few days. Common side effects include:

• Abdominal cramping
• Bloating
• Nausea
• Diarrhea
• Flatulence

Overusing laxatives can cause dehydration and the loss of electrolytes like sodium, calcium, potassium, minerals the body needs to regulate heartbeat, muscle contractions, and other essential functions. (Tropini, C. et al., 2018) Consult with a healthcare provider to ensure you use any laxative correctly, whether over-the-counter or prescription. For those thinking about using osmotic laxatives, be sure to follow the dosing instructions carefully, avoid complications, and use only when needed. Individuals with chronic constipation should see a healthcare provider so that they can identify the underlying cause. Diet, exercise, and increased fluid intake can sometimes improve the condition. Others may require treatments that extend beyond the use of laxatives.

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References

Tropini, C., Moss, E. L., Merrill, B. D., Ng, K. M., Higginbottom, S. K., Casavant, E. P., Gonzalez, C. G., Fremin, B., Bouley, D. M., Elias, J. E., Bhatt, A. S., Huang, K. C., & Sonnenburg, J. L. (2018). Transient Osmotic Perturbation Causes Long-Term Alteration to the Gut Microbiota. Cell, 173(7), 1742–1754.e17. doi.org/10.1016/j.cell.2018.05.008