Editing Laxative

{{short description|Agents that relax and loosen the bowels and stools}}
{{Redirect|Purgative||Purgation (disambiguation){{!}}Purgation}}
[[File:Glycerin suppositories.jpg|thumb|Glycerin suppositories used as laxatives.]]
'''Laxatives''', '''purgatives''', or '''aperients''' are substances that loosen [[human feces|stools]]<ref name=NIDDK>{{cite web|title=Constipation|url=http://digestive.niddk.nih.gov/ddiseases/pubs/constipation/Constipation_508.pdf|website=www.digestive.niddk.nih.gov|publisher=National Digestive Diseases Information Clearinghouse|access-date=3 November 2014}}</ref> and increase [[defecation|bowel movements]]. They are used to treat and prevent [[constipation]].

Laxatives vary as to how they work and the side effects they may have. Certain [[stimulant]], [[lubricant]], and [[saline water|saline]] laxatives are used to evacuate the [[Colon (anatomy)|colon]] for [[rectum|rectal]] and bowel examinations, and may be supplemented by [[enema]]s under certain circumstances. Sufficiently high doses of laxatives may cause [[diarrhea]]. Some laxatives combine more than one active ingredient, and may be administered [[Oral administration|orally]] or [[Rectum#Route of administration|rectally]].

==Types==

===Bulk-forming agents===
Bulk-forming laxatives, also known as [[roughage]], are substances, such as [[dietary fiber|fiber]] in food and [[hydrophilic]] agents in [[over-the-counter drugs]], that add bulk and water to [[human feces|stools]] so they can pass more easily through the [[intestines]] (lower part of the [[digestive tract]]).<ref>[http://www.cancer.gov/dictionary?CdrID=489403 Bulk-forming agent] entry in the public domain NCI Dictionary of Cancer Terms</ref>

'''Properties'''
* Site of action: [[Small intestine|small]] and [[large intestine]]s
* Onset of action: 12–72 hours
* Examples: dietary fiber, [[psyllium|Metamucil]], [[methylcellulose|Citrucel]], [[polycarbophil|FiberCon]]<ref name=Handbook>{{cite book|vauthors=Berardi M, Tietze KJ, Shimp LA, Rollins CJ, Popovich NG |title=Handbook of Nonprescription Drugs|date=2006|publisher=American Pharmaceutical Association|location=Washington, D.C.|isbn=978-1582120744|edition=15th}}</ref>
Bulk-forming agents generally have the gentlest of effects among laxatives,<ref name=NIDDK/> making them ideal for long-term maintenance of regular bowel movements.

====Dietary fiber====
Foods that help with laxation include fiber-rich foods. [[Dietary fiber]] includes [[insoluble fiber]] and [[soluble fiber]], such as:<ref name=AICR>{{cite web|title=The Facts About Fiber|url=http://www.aicr.org/assets/docs/pdf/brochures/facts-about-fiber.pdf|website=www.aicr.org|publisher=American Institute for Cancer Research|access-date=3 November 2014|archive-date=3 November 2014|archive-url=https://web.archive.org/web/20141103115438/http://www.aicr.org/assets/docs/pdf/brochures/facts-about-fiber.pdf|url-status=dead}}</ref>
* [[Fruit]]s, such as [[banana]]s,<ref>{{cite journal|last=Das|first=JL|title=Medicinal and nutritional values of banana cv. NENDRAN|journal=Asian Journal of Horticulture|year=2010|volume=8|pages=11–14|url=http://www.cabdirect.org/abstracts/20103272020.html;jsessionid=2B9A2FDF37186F0DA0A347FF227D606D|access-date=2012-11-29|archive-date=2014-11-03|archive-url=https://web.archive.org/web/20141103120544/http://www.cabdirect.org/abstracts/20103272020.html;jsessionid=2B9A2FDF37186F0DA0A347FF227D606D|url-status=dead}}</ref> though this depends on their ripeness,<ref>{{Cite news|url=http://www.medicinenet.com/top_foods_that_cause_constipation/page2.htm|title=15 Foods That Cause Constipation (Caffeine, Chocolate, Alcohol)|work=MedicineNet|access-date=2017-12-12|language=en}}</ref> [[kiwifruit]]s,<ref name=pmid12074185>{{cite journal |vauthors=Rush EC, Patel M, Plank LD, Ferguson LR | title = Kiwifruit promotes laxation in the elderly. | journal = Asia Pac J Clin Nutr | volume = 11 | issue = 2 | pages = 164–8 | year = 2002 | pmid = 12074185 | doi = 10.1046/j.1440-6047.2002.00287.x | s2cid = 15280086 }}</ref> [[prune]]s,<ref>{{cite journal |vauthors=Stacewicz-Sapuntzakis M, Bowen PE, Hussain EA, Damayanti-Wood BI, Farnsworth NR | title = Chemical composition and potential health effects of prunes: a functional food? | journal = Critical Reviews in Food Science and Nutrition | volume = 41 | issue = 4 | pages = 251–86 | year = 2001 | pmid = 11401245 | doi = 10.1080/20014091091814 | s2cid = 31159565 }}</ref> [[apples]] (with skin), [[pears]] (with skin), and [[raspberries]]<ref name=NIDDK/>
* [[Vegetables]], such as [[broccoli]], [[string beans]], [[kale]], [[spinach]],<ref name=AICR/> cooked [[winter squash]], cooked [[taro]] and [[poi (food)|poi]], cooked [[pea]]s, and baked [[potatoes]] (with skin)<ref name=NIDDK/>
* [[Whole grains]]
* [[Bran]] products<ref name=NIDDK/><ref name=AICR/>
* [[Nut (fruit)|Nuts]]
* [[Legumes]], such as [[beans]], [[peas]], and [[lentils]]<ref name=NIDDK/>

===Emollient agents (stool softeners)===
Emollient laxatives, also known as stool softeners, are [[anionic surfactant]]s that enable additional water and fats to be incorporated in the stool, making movement through the bowels easier.

'''Properties'''
* Site of action: small and large intestines
* Onset of action: 12–72 hours
* Examples: [[Docusate]] (Colace, Diocto), Gibs-Eze<ref name=Handbook/>

Emollient agents prevent constipation rather than treating long-term constipation.<ref name=Handbook/>

===Lubricant agents===
[[Lubricant]] laxatives are substances that coat the stool with slippery lipids and decrease colonic absorption of water so the stool slides through the colon more easily. Lubricant laxatives also increase the weight of stool and decrease intestinal transit time.<ref name="Handbook3">{{cite book |title=Handbook of Nonprescription Drugs |vauthors=Berardi M, Tietze KJ, Shimp LA, Rollins CJ, Popovich NG |date=2006 |publisher=American Pharmaceutical Association |isbn=978-1582120744 |edition=15th |location=Washington, D.C.}}</ref>

'''Properties'''

* Site of action: colon
* Onset of action: 6–8 hours
* Example: [[mineral oil]]<ref name="Handbook3" />

[[Mineral oil|Mineral oils]], such as [[Liquid paraffin (drug)|liquid paraffin]], are generally the only nonprescription lubricant laxative available, but due to the risk of lipid pneumonia resulting from accidental aspiration, mineral oil is not recommended, especially in children and infants.<ref name=":0">{{Cite book |last=Krinsky |first=Daniel L. |url=https://pharmacylibrary.com/doi/book/10.21019/9781582123172 |title=Handbook of Nonprescription Drugs: An Interactive Approach to Self-Care, 20th Edition |date=November 30, 2020 |publisher=The American Pharmacists Association |isbn=978-1-58212-317-2 |location=2215 Constitution Avenue, N.W. Washington, DC 20037-2985 |language=en |doi=10.21019/9781582123172.ch15}}</ref><ref>{{Cite web |last=Bowles-Jordan |first=Jane |title=Constipation |url=http://proxycheck.lib.umanitoba.ca/libraries/online/proxy.php?http://www.e-therapeutics.ca/?p=mzLm9vCs3qxZyEUHPZaNJ7uOeM6sKtN-Az2x-dKQMNz0daKJqHkuaoQKNMbtytXe&logintype=auto&auto=true |access-date=March 20, 2020 |website=CPS}}</ref> Mineral oil may decrease the absorption of fat-soluble vitamins and some minerals.<ref name="Handbook3" />

===Hyperosmotic agents===<!--This section is linked from [[Glycerol]]-->

[[Tonicity#Hypotonic solution|Hyperosmotic]] laxatives cause the intestines to hold more water, creating an [[osmotic gradient]], which adds more pressure and stimulates bowel movement.<ref name="Handbook22">{{cite book |title=Handbook of Nonprescription Drugs |vauthors=Berardi M, Tietze KJ, Shimp LA, Rollins CJ, Popovich NG |date=2006 |publisher=American Pharmaceutical Association |isbn=978-1582120744 |edition=15th |location=Washington, D.C.}}</ref><ref name=":0" />

'''Properties'''

* Site of action: colon
* Onset of action: 12–72 hours (oral), 0.25–1 hour (rectal)
* Examples: [[Glycerol|glycerin]] suppositories (Hallens), [[sorbitol]], [[lactulose]], and [[polyethylene glycol]] ([[Macrogol|PEG]] - Colyte, MiraLax)<ref name="Handbook22" />

[[Lactulose]] works by the [[Osmosis|osmotic]] effect, which retains water in the colon; lowering the [[pH]] through bacterial fermentation to lactic, formic, and acetic acids; and increasing colonic [[peristalsis]]. Lactulose is also indicated in [[Hepatic encephalopathy|portal-systemic encephalopathy]]. Glycerin suppositories work mostly by hyperosmotic action, but the [[sodium stearate]] in the preparation also causes local irritation to the colon.{{cn|date=March 2023}}

Solutions of [[polyethylene glycol]] and electrolytes ([[sodium chloride]], [[sodium bicarbonate]], [[potassium chloride]], and sometimes [[sodium sulfate]]) are used for [[whole bowel irrigation]], a process designed to prepare the bowel for surgery or [[colonoscopy]] and to treat certain types of [[Poison|poisoning]]. Brand names for these solutions include GoLytely, GlycoLax, Cosmocol, CoLyte, Miralax, Movicol, NuLytely, Suprep, and Fortrans. Solutions of [[sorbitol]] (SoftLax) have similar effects.{{cn|date=March 2023}}

===Saline laxative agents===
Saline laxatives are nonabsorbable, osmotically active substances that attract and retain water in the intestinal lumen, increasing intraluminal pressure that mechanically stimulates evacuation of the bowel. Magnesium-containing agents also cause the release of [[cholecystokinin]], which increases intestinal motility and fluid secretion.<ref name=Handbook/> Saline laxatives may alter a patient's fluid and electrolyte balance.

'''Properties'''
* Site of action: small and large intestines
* Onset of action: 0.5–3 hours (oral), 2–15 minutes (rectal)
* Examples: [[Sodium phosphates|sodium phosphate]] (and variants), [[magnesium citrate]], [[magnesium hydroxide]] (milk of magnesia), and [[magnesium sulfate]] (Epsom salt)<ref name=Handbook/>

===Stimulant agents===
Stimulant laxatives are substances that act on the intestinal [[mucosa]] or [[nerve plexus]], altering water and [[electrolyte]] secretion.<ref>[http://www.mayoclinic.com/health/drug-information/DR602359 Laxative (Oral Route)] from [[Mayo clinic]]. Last updated: Nov. 1, 2012</ref> They also stimulate peristaltic action and can be dangerous under certain circumstances.<ref name=pmid9649012>{{cite journal |vauthors=Joo JS, Ehrenpreis ED, Gonzalez L, Kaye M, Breno S, Wexner SD, Zaitman D, Secrest K | title = Alterations in colonic anatomy induced by chronic stimulant laxatives: the cathartic colon revisited | journal = J Clin Gastroenterol | volume = 26 | issue = 4 | pages = 283–6 | year = 1998 | pmid = 9649012 | doi = 10.1097/00004836-199806000-00014 }}</ref>
[[File:Cassia senna Ypey80-cropped.jpg|thumb|Senna plant]]
'''Properties'''
* Site of action: colon
* Onset of action: 6–10 hours
* Examples: [[senna glycoside|senna]], [[bisacodyl]]<ref name=Handbook/>

Prolonged use of stimulant laxatives can create drug dependence by damaging the colon's [[Haustrum (anatomy)|haustral folds]], making users less able to move feces through their colon on their own. A study of patients with chronic constipation found that 28% of chronic stimulant laxative users lost haustral folds over the course of one year, while none of the control group did.<ref>{{cite journal |last1=Joo |first1=Jae Sik |last2=Ehrenpreis |first2=Eli D. |last3=Gonzalez |first3=Leopoldo |last4=Kaye |first4=Mark |last5=Breno |first5=Susan |last6=Wexner |first6=Steven D. |last7=Zaitman |first7=Daniel |last8=Secrest |first8=K. |title=Alterations in Colonic Anatomy Induced by Chronic Stimulant Laxatives: The Cathartic Colon Revisited |journal=Journal of Clinical Gastroenterology |date=June 1998 |volume=26 |issue=4 |pages=283–286 |doi=10.1097/00004836-199806000-00014 |pmid=9649012 }}</ref>

===Miscellaneous===
[[Castor oil]] is a glyceride that is hydrolyzed by pancreatic lipase to [[ricinoleic acid]], which produces laxative action by an unknown mechanism.

'''Properties'''
* Site of action: colon, small intestine (see below) {{citation needed|date=September 2018}}
* Onset of action: 2–6 hours
* Examples: castor oil<ref name=Handbook/>

Long-term use of castor oil may result in loss of fluid, electrolytes, and nutrients.<ref name=Handbook/>

===Serotonin agonist===
These are motility stimulants that work through activation of [[serotonin|5-HT<sub>4</sub>]] receptors of the [[enteric nervous system]] in the [[gastrointestinal tract]]. However, some have been discontinued or restricted due to potentially harmful cardiovascular side effects.

[[Tegaserod]] (brand name [[Zelnorm]]) was removed from the general U.S. and Canadian markets in 2007, due to reports of increased risks of heart attack or stroke. It is still available to physicians for patients in emergency situations that are life-threatening or require hospitalization.<ref>{{cite web|url=https://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm103223.htm|archive-url=https://web.archive.org/web/20090603133746/http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm103223.htm|url-status=dead|archive-date=June 3, 2009|title=Postmarket Drug Safety Information for Patients and Providers - Zelnorm (tegaserod maleate) Information|first=Center for Drug Evaluation and|last=Research|website=www.fda.gov|access-date=14 April 2018}}</ref>

[[Prucalopride]] (brand name Resolor) is a current drug approved for use in the EU since October 15, 2009,<ref>{{cite web|url=http://www.emea.europa.eu/docs/en_GB/document_library/EPAR_-_Summary_for_the_public/human/001012/WC500053995.pdf|title=European Medicines Agency EPAR summary for the public|website=europa.eu|access-date=14 April 2018|archive-date=14 April 2018|archive-url=https://web.archive.org/web/20180414233759/http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Summary_for_the_public/human/001012/WC500053995.pdf|url-status=dead}}</ref> in Canada (brand name Resotran) since December 7, 2011,<ref>{{cite web|url=http://www.hc-sc.gc.ca/dhp-mps/prodpharma/sbd-smd/drug-med/sbd_smd_2012_resotran_141157-eng.php#a2|title=Health Canada, Notice of Decision for Resotran|website=hc-sc.gc.ca|access-date=14 April 2018|archive-url=https://web.archive.org/web/20170318120956/http://www.hc-sc.gc.ca/dhp-mps/prodpharma/sbd-smd/drug-med/sbd_smd_2012_resotran_141157-eng.php#a2|archive-date=18 March 2017|url-status=dead}}</ref> and in the United States since December 2018.

===Chloride channel activators===
[[Lubiprostone]] is used in the management of chronic idiopathic constipation and irritable bowel syndrome. It causes the intestines to produce a chloride-rich fluid secretion that softens the stool, increases motility, and promotes spontaneous bowel movements.

==Comparison of available agents==
{| class="wikitable sortable" border="1"
|+Common stimulant laxatives<ref name="itm-safety">{{cite web|url=http://www.itmonline.org/arts/laxatives.htm|title=SAFETY ISSUES AFFECTING HERBS: How Long can Stimulant Laxatives be Used?|first=Subhuti|last=Dharmananda|publisher=Institute for Traditional Medicine|access-date=2010-03-19}}</ref><ref name="fpnb">{{cite web|url=http://www.fpnotebook.com/GI/Pharm/StmlntLxtv.htm|title=Stimulant Laxatives|date=2010-02-26|publisher=Family Practice Notebook, LLC|access-date=2010-03-19}}</ref>
|-
! Preparation(s) !! Type !! Site of action !! Onset of action
|-
| [[Rhamnus purshiana|Cascara]] ([[casanthranol]])|| [[Anthraquinone]] || [[Colon (anatomy)|colon]] || <span style="display:none">3</span>6–8 hours
|-
| [[Buckthorn]] || Anthraquinone || colon || <span style="display:none">3</span>6–8 hours
|-
| [[Senna (herb)|Senna extract]] ([[senna glycoside]]) || Anthraquinone || colon || <span style="display:none">3</span>6–8 hours
|-
| [[Aloe vera]] ([[aloin]]) || Anthraquinone || colon || <span style="display:none">5</span>8–10 hours
|-
| [[Phenolphthalein]] || [[Triphenylmethane]] || colon || <span style="display:none">4</span>8 hours
|-
| [[Bisacodyl]] ([[oral administration|oral]]) || Triphenylmethane || colon || <span style="display:none">6</span>6–12 hours
|-
| Bisacodyl ([[suppository]]) || Triphenylmethane || colon || <span style="display:none">1</span>60 minutes
|-
| Castor oil || [[Ricinoleic acid]] || small intestine || <span style="display:none">2</span>2–6 hours
|}

===Effectiveness===
For adults, a [[randomized controlled trial]] found [[polyethylene glycol|PEG]] (MiraLax or GlycoLax) 17&nbsp;grams once per day to be superior to [[tegaserod]] at 6&nbsp;mg twice per day.<ref name="pmid17573794">{{cite journal |vauthors=Di Palma JA, Cleveland MV, McGowan J, Herrera JL | title = A randomized, multicenter comparison of polyethylene glycol laxative and tegaserod in treatment of patients with chronic constipation | journal = Am. J. Gastroenterol. | volume = 102 | issue = 9 | pages = 1964–71 | year = 2007 | doi = 10.1111/j.1572-0241.2007.01365.x | pmid = 17573794 | s2cid = 32055676 }}</ref> A randomized controlled trial found greater improvement from two sachets (26&nbsp;g) of PEG versus two sachets (20&nbsp;g) of lactulose.<ref name=pmid9895382>{{cite journal |vauthors=Attar A, Lémann M, Ferguson A, Halphen M, Boutron MC, Flourié B, Alix E, Salmeron M, Guillemot F, Chaussade S, Ménard AM, Moreau J, Naudin G, Barthet M | title = Comparison of a low dose polyethylene glycol electrolyte solution with lactulose for treatment of chronic constipation | journal = Gut | volume = 44 | issue = 2 | pages = 226–30 | year = 1999 | pmid = 9895382 | pmc = 1727381 | doi = 10.1136/gut.44.2.226 }}</ref> 17&nbsp;g per day of PEG has been effective and safe in a randomized, controlled trial for six months.<ref name="pmid17403074">{{cite journal |vauthors=Dipalma JA, Cleveland MV, McGowan J, Herrera JL | title = A randomized, multicenter, placebo-controlled trial of polyethylene glycol laxative for chronic treatment of chronic constipation | journal = Am. J. Gastroenterol. | volume = 102 | issue = 7 | pages = 1436–41 | year = 2007 | doi = 10.1111/j.1572-0241.2007.01199.x | pmid = 17403074 | s2cid = 10946562 }}</ref> Another randomized, controlled trial found no difference between sorbitol and lactulose.<ref name=pmid2122724>{{cite journal |vauthors=Lederle FA, Busch DL, Mattox KM, West MJ, Aske DM | title = Cost-effective treatment of constipation in the elderly: a randomized double-blind comparison of sorbitol and lactulose | journal = Am J Med | volume = 89 | issue = 5 | pages = 597–601 | year = 1990 | pmid = 2122724 | doi = 10.1016/0002-9343(90)90177-F }}</ref>

For children, PEG was found to be more effective than lactulose.<ref>{{cite web |url=http://www.bestbets.org/cgi-bin/bets.pl?record=00901 |title=BestBETs: Is polyethylene glycol safe and effective for chro... |access-date=2007-09-06 }}</ref>

==Problems with use==

===Laxative abuse===
Some of the less significant adverse effects of laxative abuse include [[dehydration]] (which causes tremors, weakness, fainting, blurred vision, kidney damage), [[hypotension|low blood pressure]], [[tachycardia|fast heart rate]], postural dizziness and [[syncope (medicine)|fainting]];<ref name="Laxative abuse review" /> however, laxative abuse can lead to potentially fatal [[acid-base imbalance|acid-base]], and [[electrolyte imbalance]]s.<ref name="Laxative abuse review" /> For example, severe [[hypokalaemia]] has been associated with [[distal renal tubular acidosis]] from laxative abuse.<ref name="Laxative abuse review" /> [[Metabolic alkalosis]] is the most common acid-base imbalance observed.<ref name="Laxative abuse review" /> Other significant adverse effects include [[rhabdomyolysis]],<ref name="Laxative abuse review" /> [[steatorrhoea]],<ref name="Laxative abuse review" /> [[inflammation]] and [[ulceration]] of colonic mucosa,<ref name="Laxative abuse review" /> [[pancreatitis]],<ref name="Laxative abuse review" /><ref name=Brown>{{cite journal |vauthors=Brown NW, Treasure JL, Campbell IC | title = Evidence for long-term pancreatic damage caused by laxative abuse in subjects recovered from anorexia nervosa | journal = International Journal of Eating Disorders | volume = 29 | issue = 2 | pages = 236–238 | year = 2001 | pmid = 11429987 | doi = 10.1002/1098-108X(200103)29:2<236::AID-EAT1014>3.0.CO;2-G }}</ref> [[kidney failure]],<ref name="Laxative abuse review" /><ref name=copeland>{{cite journal | author = Copeland PM | title = Renal failure associated with laxative abuse | journal = Psychother Psychosom | volume = 62 | issue = 3–4 | pages = 200–2 | year = 1994 | pmid = 7531354 | doi = 10.1159/000098619 | last5 = Alaminos | last4 = MacIas | last7 = Teijeiro | last6 = Alvarez | last3 = Ohye | last2 = Molina | last9 = Ortega | last8 = Muñoz | first8 = J. | first9 = I. | first2 = H. | first3 = Ch. | first4 = R. | first5 = A. | first6 = L. | first7 = J. }}</ref><ref name=wright>{{cite journal |vauthors=Wright LF, DuVal JW | title = Renal injury associated with laxative abuse | journal = South Med J | volume = 80 | issue = 10 | pages = 1304–6 | year = 1987 | pmid = 3660046 | doi = 10.1097/00007611-198710000-00024 }}</ref> [[factitious diarrhea]]<ref name="Laxative abuse review" /><ref>{{cite journal |vauthors=Oster JR, Materson BJ, Rogers AI | title = Laxative abuse syndrome | journal = Am. J. Gastroenterol. | volume = 74 | issue = 5 | pages = 451–8 | date = November 1980 | pmid = 7234824 }}</ref> and other problems.<ref name="Laxative abuse review">{{cite journal | vauthors = Roerig JL, Steffen KJ, Mitchell JE, Zunker C | title = Laxative abuse: epidemiology, diagnosis and management | journal = Drugs | volume = 70 | issue = 12 | pages = 1487–1503 | year = 2010 | pmid = 20687617 | doi = 10.2165/11898640-000000000-00000 | s2cid = 29007249 }}</ref> The colon will need more quantities of laxatives to keep functioning, this will result in a lazy colon, infections, irritable bowel syndrome, and potential liver damage.

Although some patients with eating disorders such as [[anorexia nervosa]] and [[bulimia nervosa]] abuse laxatives in an attempt to lose weight, laxatives act to speed up the transit of feces through the large intestine, which occurs after the absorption of nutrients in the small intestine is already complete. Thus, studies of laxative abuse have found that effects on body weight reflect primarily temporary losses of body water rather than energy (calorie) loss.<ref name="Laxative abuse review" /><ref name=Lacey>{{cite journal |vauthors=Lacey JH, Gibson E | title = Controlling weight by purgation and vomiting: A comparative study of bulimics | journal = Journal of Psychiatric Research | volume = 19 | issue = 2–3 | pages = 337–341 | year = 1985 | pmid = 3862833 | doi = 10.1016/0022-3956(85)90037-8 }}</ref><ref>{{Cite web|url=http://www.uptodate.com/contents/acid-base-and-electrolyte-abnormalities-with-diarrhea-or-ureteral-diversion|title=Acid-base and electrolyte abnormalities with diarrhea|website=www.uptodate.com|access-date=2017-12-12}}</ref>

===Laxative gut===
Physicians warn against the chronic use of stimulant laxatives due to concern that chronic use could cause the colonic tissues to get worn out over time and not be able to expel feces due to long-term overstimulation.<ref>{{cite journal |vauthors=Joo JS, Ehrenpreis ED, Gonzalez L, Kaye M, Breno S, Wexner SD, Zaitman D, Secrest K | title = Alterations in colonic anatomy induced by chronic stimulant laxatives: the cathartic colon revisited | journal = Journal of Clinical Gastroenterology | volume = 26 | issue = 4 | pages = 283–6 | date = June 1998 | pmid = 9649012 | doi = 10.1097/00004836-199806000-00014 }}</ref>  A common finding in patients having used stimulant laxatives is a brown pigment deposited in the intestinal tissue, known as [[melanosis coli]].{{citation needed|date=October 2012}}

==Historical and health fraud uses==
Laxatives, once called "physicks" or "purgatives", were used extensively in [[history of medicine|historic medicine]] to treat many conditions for which they are now generally regarded as ineffective in [[evidence-based medicine]].<ref>{{Cite journal|last=Stolberg|first=Michael|date=2003|title=[The miraculous effects of taking laxatives. Success and failure of pre-modern medical treatment from the patients' perspective]|journal=Wurzburger Medizinhistorische Mitteilungen|volume=22|pages=167–177|issn=0177-5227|pmid=15641192}}</ref> Likewise, laxatives (often termed [[colon cleanse]]s) may be promoted in [[alternative medicine]] for various conditions of [[quackery]], such as "[[mucoid plaque]]".<ref>{{Cite book|title=Illustrated medical pharmacology|last=M.|first=Raju, S.|isbn=9789350906552|oclc=870530462|date = 2013-09-30|publisher=JP Medical }}</ref>

==See also==
{{col div|colwidth=20em}}
* [[ATC code A06]]
* [[Bowel management]]
* [[Cathartic]]
* [[Dietary fiber]]
* [[Diuretic]]
* [[Maltitol]]
* [[Enema]]
* [[Suppository]]
* [[Transanal irrigation]]
{{colend}}

==References==
{{reflist}}

{{Commons category|Laxatives}}

{{Major Drug Groups}}
{{Laxatives}}
{{Irritable bowel syndrome}}
{{Authority control}}
{{Portal bar | Medicine}}

[[Category:Laxatives| ]]
[[Category:Gastroenterology]]