This list contains OTC medication that is used for Self-Care
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● Age < 2 years old
● Dark, tarry or bloody stool ● Daily laxative use ● Fever/Nausea/vomiting ● Anorexia |
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● Chronic medical condition that precludes self-care laxative treatment
● Severe abdominal distention, cramping, or pain ● Severe or unexplained flatulence ● Severe change in stool character ● Unexplained bowel habit changes, especially with weight loss ● Bowel symptoms that continue for >2 weeks OR recur over 3 months or longer ● Bowel symptoms that persist after dietary or lifestyle changes or laxative use |
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Lifestyle changes
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‣ Balanced Diet
‣ Fiber: 14g per 1,000kcal -OR- Women: 25 g/day Men: 38 g/day |
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Fluid Intake
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‣ 2 L water/day
‣ Pregnancy: extra 300 mL/day ‣ Lactating: extra 750 - 1,000 mL/day |
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Exercise
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‣ 150 minutes/week
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Bowel Training
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‣ Regularly-scheduled attempts (Usually first thing in the morning)
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Saline
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Liquid and solid (PO), Liquid (rectal)
‣ Mag Citrate/Hydroxide/Sulfate ‣ Dibasic/Monobasic Sodium phosphate |
Draw water into the intestine/colon (PO) via Osmosis
→ increase intraluminal pressure → promote GI motility |
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Hyperosmotic
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‣ Glycerin (Rectal Suppository/Enema)
‣ PEG 3350 (PO powder) |
Large, poorly-absorbed ions/molecules draw water into the colon and rectum via osmosis
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Emollients
(aka Stool Softeners) |
‣ Docusate Sodium/Calcium (PO Capsule and Syrup)
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Anionic Surfactants
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Lubricants
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‣ Mineral oil (PO/PR Liquid)
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Coats stool and prevent colonic absorption of fecal water
→ softens fecal contents |
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Bulk-Forming (DOC)
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‣ Methylcellulose, polycarbophil, psyllium-containing products (PO)
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(Mimic what the body does naturally) Absorb water in intestine
→ provides bulk → promotes peristalsis |
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Stimulants
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‣ Senna, Bisacodyl (PO Caps/Tabs; PR Supp.)
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(Increase gastric motility in colon)
Local irritation of mucosa or more selective action on intramural nerve plexus of intestinal smooth muscle + increased water and electrolyte secretion by the intestine |
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Faster Relief
(within 15 min - 6 hours) |
Lubricants
‣ Mineral oil (PR): 5-15 minutes |
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Saline Laxatives
‣ Magnesium citrate (PR): 2-15 min ‣ Magnesium citrate (PO): 30 min - 3 hours ‣ Magnesium hydroxide: 30 min-6 hours |
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Hyperosmotic
‣ Glycerin (PR): 15-30 minutes |
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Stimulants
‣ Bisacodyl (PR): 15-60 minutes ‣ Senna (PO): 6-10 hours ‣ Bisacodyl (PO): 6-10 hours |
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Slower Relief
(6+ hours, up to 72 hours) |
Bulk-Forming Agents
‣ Methylcellulose, Polycarbophil, Psyllium-containing products (PO): 12-24 hours, up to 72 hours |
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Emollients (Stool Softeners)
‣ Docusate Na/Ca: 12-72 hours, up to 3-5 days |
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Lubricants
‣ Mineral oil (PO): 6-8 hours |
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Hyperosmotic
‣ PEG 3350 (PO): 12-72 hours (up to 96 hours) |
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Saline
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AVOID IN:
‣ Intolerant of fluid loss, Electrolyte imbalances, Renal impairment, Newborns, Older adults, or CHF (sodium phosphate) ‣ PR Sodium phosphate: megacolon, GI obstruction, anus perforation, colostomy |
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Hyperosmotic
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PEG 3350: Caution in renal disease, IBS
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Glycerin: Pre-existing rectal irritation
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Emollients
(aka Stool Softeners) |
Caution: Electrolyte imbalances
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Lubricants
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Avoid in: < 6 years, Pregnancy, Bedridden, Older adults, Difficulty swallowing, Risk for aspiration because Risk of Lipid Pneumonia when taken PO
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DDIs: Fat-soluble vitamins (ADEK) and Docusate (emollient)
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Bulk-Forming (DOC)
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Avoid in: Difficulty swallowing, esophageal strictures, intestinal ulcerations/stenosis/disabling adhesions, and psyllium allergy
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Caution: Renal disease (calcium content), diabetes, restricted caloric intake, fluid intake
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DDIs: Digoxin, Anti-coagulants, Salicylates (separate by 2 hours)
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Stimulants
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Senna: Melanotic pigmentation of colonic mucosa, may discolor urine (pink/red/violet/brown)
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Children
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Mild constipation
‣ Dietary Modifications: > 2 yo extra fiber intake = (age + 5 g/day) ‣ Behavioral Modifications: establish regular stooling time (if toilet trained) |
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IF Modifications insufficient in 2 – 6 years old
‣ PO: Senna, Docusate sodium, Magnesium hydroxide ‣ Rectal: Glycerin, mineral oil, sodium phosphate |
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IF Modifications insufficient in 6 – 12 years old
‣ PO: Senna, Docusate sodium, Magnesium hydroxide, bulk-forming, mineral oil, Magnesium (any formulation), Bisacodyl ‣ Rectal: Glycerin, mineral oil, sodium phosphate, Bisacodyl |
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Pregnancy/Lactation
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Goal: Achieve soft stools WITHOUT laxative use
‣ First-line: Dietary (increase fibers) ‣ Second-line: Bulk-forming with plenty of fluid, Docusate, PEG 3350, (maybe short-term) Senna/Bisacodyl ‣ Breastfeeding: Senna, Bisacodyl, PEG 3350, Docusate |
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Older Adults
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ALWAYS FLUID and FIBER
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Bulk-forming Laxative (Avoid in dehydration, frailty, bedridden, unable to maintain hydration)
‣ If bulk-forming is contraindicated: PEG 3350 or Docusate ‣ AVOID: Mineral oil and Saline because of fluid and electrolyte imbalance |
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