There are generally four types of laxatives.
1. Bulking agents
Food such as bran, or products such as Citrucel, Metamucil, Fibercon and plants like psyllium, chia, and flax can ease occasional constipation by absorbing more fluid in the intestines. This makes the stool bigger, which gives you the urge to pass the stool.
Risks: Bulking agents attract water and regular use can pull excess water off the intestinal wall. Over time, this can dehydrate the bowel and cause more chronic elimination concerns. In addition, most bulking agents expand greatly inside the intestines and, if used excessively, they can potentially distend the intestines, reducing their ability to contract and move fecal matter to the toilet. This can eventually result in a chronically sluggish, overly distended and dehydrated bowel.
2. Stool softeners
Products such as Colace lubricate and soften the stool in the intestine, making it easier to pass. Stool softeners do not often cause problems but they don’t work as well if you don’t drink enough water during the day.
Risks: The side effects from stool softeners can include sore throat, nausea, and skin rashes associated with dehydration. Stool softeners are also potentially habit forming and are not considered safe to use for more than 1 week without a doctor’s supervision.
3. Osmotic laxatives
Products such as Fleet Phospho-Soda, Magnesium, Milk of Magnesia, or Miralax and non-absorbable sugars, such as lactulose or sorbitol, hold fluids in the intestine and draw fluids into the intestine from other tissue and blood vessels. This extra fluid in the intestines makes the stool softer and easier to pass. Drink plenty of water if you use this type of laxative.
Risks: Once again, the mechanism for somatic laxatives is to pull water off the stool. Long term use can dehydrate the bowel making it more challenging for natural regular elimination, leading to dependency. Side effects can include malabsorption of key minerals, electrolyte disturbances and kidney strain.
4. Stimulant laxatives
Products such as Correctol, Dulcolax, Ex-Lax, Feen-a-Mint, or Senokot speed up how fast a stool moves through the intestines by irritating the lining of the intestines. Regular use of stimulant laxatives is not recommended as it can compromise the absorption of vitamin D through the intestinal wall.
Herbal stimulant laxatives include Cascara sagrada, Senna, Aloe latex, Frangula and prunes. Herbal laxatives that stimulate or irritate the bowel employ a constituent called Anthranoids that induce gut motility, stimulating a decrease in transit time. They also reduce fluid absorption and increase secretion in the colon, with the “end result” of softer stools.
Risks: Stimulant laxatives change the tone and feeling in the large intestine and can easily and quickly create a chemical dependency. Large doses can result in cramping and watery stools. Additionally, studies are inconclusive as to their overall efficacy. (8)
As bowel irritants, long term use can irritate and inflame the intestinal wall. Controversy exists as to whether this causes severe or lasting harm to the gut, but Ayurveda clearly says to be kind and gentle to the intestinal skin. (8)