He warns that prolonged use of laxatives can weaken the abdominal muscles because they are prevented from doing their normal job of expelling the stool, leaving the colon lazy. Then, too, laxatives can flush out the vitamins, minerals and other vital nutrients from the body.
What Dr. Rosenfeld prescribes instead is for one to increase his fiber intake, drink more water and start a regular exercise program. But if you gotta go and you need help, the doctor suggests you take the mildest preparation for the shortest length of time.
Dr. Rosenfeld names the more common laxatives as follows:
• Bulk laxatives (both natural and synthetic) which account for 25 percent of all laxative sales. They’re essentially some form of fiber and they work by drawing water into the bowel to make stool softer and easier to expel. The known brands are derived from seeds of the psyllium plant which can cause the stool to harden and obstruct bowel so be sure to take each dose with a full glass of water. They’re safer over the long term than stimulant laxatives. A major downside to their long-term use is they interfere with the absorption of other medications that you may be taking. Thus, this friendly reminder: Don’t take any other drugs at the same time as a bulk laxative. Wait an hour or two.
• Saline laxatives (like Milk of Magnesium) take effect within three hours. They’re the preferred laxatives for cleaning out the colon before surgery or after a bowel x-ray. They should be used only for one-time solution, never on a continuing basis. And because it’s salt, avoid it if you have high blood pressure, kidney problems, etc.
• Stimulant laxatives make up 25 percent of all bowel regulators sold on the market. They should be the last resort because they irritate the lining of the colon, making it contract to expel its contents. They can cause cramps especially in older people. If used regularly, they can result in dependence, vitamin deficiency and loss of nutrients.
The most widely used stimulant laxative is castor oil. It is, however, not recommended as it can interfere with the absorption of dietary nutrients. Most stimulant laxatives are available in tablets and suppositories which have protective coating to prevent their absorption in the stomach. A quick caveat: Don’t chew or crush them because they can damage the tissues of your mouth and stomach.
The ingredient phenolphthalein in laxatives has been banned by FDA because it has been found to cause cancer in rodents.
What about enemas which have become a way of life for some people? An occasional enema to get rid of an acute problem won’t hurt. "But high colonics at regular intervals are a fad," Dr. Rosenfeld points out. "Feeling clean is only a state of mind. There’s no proof that it removes toxins. They just remove stool."
Truth of the matter is, the bowels have the ability to cleanse themselves, says Dr. Rosenfeld. They don’t need the ritual of high colonics to do their job. Sending in 10 or 15 gallons of water only upsets their normal function, Dr. Rosenfeld adds.
• Stool softeners only soften the stool but will not move you.
• Mineral oil does keep stool soft, but it also prevents the absorption of important fat-soluble vitamins like A, D, E and K. Then there’s the danger of an older person inadvertently inhaling the mineral oil while trying to swallow it and contracting lipoid (fat pneumonia). More, it is also messy to use and can soil your clothes. So take it rectally rather than orally. If you’re taking it orally, take it at bedtime on an empty stomach and never with a stool softener like Colace as it causes increased absorption of mineral oil in the body.
If everything else fails, a half-cup of dried kidney beans may do the trick. Kidney beans are an excellent fiber laxative and likewise rich in vitamins, proteins, minerals and carbohydrates.
To recap, Dr. Rosenfeld gives some pointers about constipation, thus:
• Constipation means two or less bowel movements a week. A continuing decrease in the number of movements, accompanied by hard, dry stool, can mean you’re in trouble.
• Constipation is a (stressed) lifestyle disorder, not a disease. Most cases are largely due to too little water and fiber in one’s diet.
• There are certain predisposing conditions for constipation like weak abdominal walls, stroke, medications, diabetes, etc.
• If constipation persists (especially when alternating with diarrhea or accompanied by a change in stool size or shape), see a doctor.