Laxatives - Important Notes
- It should be remembered that a change in bowel habit might indicate the need for investigation rather than an automatic prescription.
- A digital rectal examination (DRE) may be required to establish if there is faecal matter in the rectum, the amount and consistency and the need for enemas. Ref RCN guidelines “Digital Rectal examination and manual removal of faeces” April 2004.
- There is little evidence on which to judge the relative effectiveness and tolerability of individual laxatives. Therefore choice should be based on symptoms, patient preferences, side effects and cost of medicines.
- Care should be taken with bulk forming laxatives. Patients should be advised to take them immediately with adequate fluid, (ensuring at least 1.5 litres per day).
- Lactulose takes up to 48 hours to work but is often inappropriately used “when required”. It is unpleasant to take and compliance may be a problem. Its main clinical benefit is in the management of hepatic encephalopathy. It is important to ensure a minimum fluid intake of 1.5 litres per day.
- Laxido® should be reserved only for patients where other treatments have been ineffective. Caution: may cause electrolyte disturbances. (Idrolax® is a polyethylene glycol preparation without electrolytes if a salt free preparation is required).
- Ongoing reassessment of the patient’s bowel habit is essential.