Constipation and surviving myths. Laxatives
Jan Martínek Orcid.org 1,2
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Summary
Constipation is a set of symptoms which affects up to 20% of the population. If caused by a specific disease, we speak about secondary constipation. Secondary constipation is treated based on its actual cause. Primary constipation is caused either by insufficient large bowel motility (so-called colon inertia syndrome or inert colon) or by problematic evacuation dueto defecation reflex disturbances (= anismus) or anatomical changes in the rectum region (= obstructive defecation syndrome, ODS). Anismus and ODS represent "terminal" constipation. A patient with longer-lasting constipation should undergo a thorough examination by a gastro-enterologist. Terminal constipation can successfully be resolved by physiotherapy or surgery. On the contrary, colon inertia syndrome can often only be resolved by the long-term administration of laxatives. We distinguish bulk-forming, stimulant, osmotic and other laxatives. Laxatives are used not only in patients with constipation but also for bowel "cleansing" before surgical and diagnostic interventions in the large bowel. Many myths exist with respect to laxatives, which are traditionally "copied" from one textbook to another and are rooted in the thinking of both doctors and the general public. Such myths say, for instance, that stimulant laxatives cause harm, are addictive and worsen the already present constipation. None of that has ever been scientifically proven. Stimulant laxatives are fully efficient and safe even if used for a period over 15 years. Recently, a number of studies have been published which prove both the efficacy and safety of stimulant laxatives. Unequivocal data on their absolute safety in long-term use are lacking, however, no information exists on their harmfulness if taken over a long time. Therefore, discouraging a patient from taking laxatives if they are efficient can currently be considered the wrong attitude. The following article summarises, in particular, current laxative-related issues.
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