Constipation is a very common ailment, especially in children. While most treatments are considered safe for short-term or intermittent use, always discuss long-term treatment options with your healthcare provider. Understanding the differences among medications, their safety profiles and mechanisms of action hopefully will help you approach treatment options and discussions of those options with more confidence and knowledge.
Every workday, I receive at least one question from a concerned parent about the safety of constipation medications. They often worry about everything from medication dependency to potential harmful effects on young, growing bodies.
As a mom and a physician, I understand these concerns and am quick to acknowledge their angst. Many families believe that laxatives and stool softeners are mostly all the same when, in fact, there are several different types and categories. Their mechanisms of action and potential side effects also vary widely. Here is a quick reference guide to hopefully clarify when certain medications might be appropriate and when concerns may be justified.
The first, and arguably most important, distinction among laxatives is stimulant versus non-stimulant. Stimulant medications are the category that can lead to bowel dependency because they “tell” your gut when to contract. Over time, the gut “forgets” how to contract without the direction of the medication. Non- stimulants, such as softeners or lubricants, do not work this way. They don’t “make” your gut function; they just allow it to, and therefore are not habit forming.Specific types of “non-stimulant” laxatives include hyperosmotic laxatives, saline laxatives and lubricant laxatives.
Hyperosmotic laxatives include medications such as Miralax and lactulose. These medications are essentially water magnets. Upon taking them orally, these medications attract water into the gut. This water mixes with
stool to soften it. When stool evacuation occurs, these medications essentially are evacuated
as well. There is little to no absorption of these medications, making them safe for longer-term use. They may take a little longer to work in people with a history of chronic constipation, but they are a good option for those with chronic stooling difficulties.
Saline laxatives, such a milk of magnesia and magnesium citrate, work similarly. They attract water into the intestines like the hyperosmotic laxatives, but they also promote contraction of the colon. These laxatives are not habit forming, but due to the vigorous nature of the reaction, they should not be used long term due to the potential for dehydration and/or electrolyte disturbances, especially in young children.
Lubricant laxatives serve to essentially “lube the chute”; mineral oil is a classic example. Lubricant laxatives are not habit forming, but they can form a barrier to the absorption of certain vitamins, namely vitamins A, D, E and
K. Therefore, lubricants like mineral oil are not appropriate for long-term use. Mineral oil always should be used with caution in young children or anyone at risk for respiratory aspiration. Aspiration of mineral oil into the lungs can be devastating to the lungs and respiratory system.
The other category, stimulant laxatives, include medications such as bisacodyl (Dulcolax) and sennosides (senna). This category of medications can lead to bowel dependency with long-term use. Additionally, when used frequently, they can cause dehydration and electrolyte imbalances. Occasional use is generally regarded as safe although they can be associated with abdominal cramping.
Constipation is a very common ailment, especially in children. While most treatments are considered safe for short-term or intermittent use, always discuss long-term treatment options with your healthcare provider. Understanding the differences among medications, their safety profiles and mechanisms of action hopefully will help you approach treatment options and discussions of those options with more confidence and knowledge.
Dr. April Ulmer, a.k.a. “The Tummy Dr.,” is a board-certified pediatric gastroenterologist who practices at Kids and Tummies in Gulfport. Reach her at thetummydr@gmail.com.
