# Do Stimulant Laxatives Hurt the Colon?



## CinNJ (Mar 6, 2004)

I've read articles that say that stimulant laxatives like senna, cascara sagrada and buckthorn can cause damage to the colon. I've read other people say that they've used them for years without trouble. I have IBS-C and do not get much help from Zelnorm, Amitiza and supplements. I'd like to move to one of the laxative teas - but I'm concerned that they will damage my colon permanently (it does need some abuse - it is one lazy colon). Thoughts?


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## 16636 (Sep 29, 2006)

I don't know if your colon needs some abuse...but I know what you mean! There is research out now saying that stimulant laxatives don't cause dependency -- however, I believe that regular use by some people can lead to a need for higher doses to produce the same effect. Not sure WHY that's not considered addictive...maybe Kathleen or someone can explain it to me.There are other people who never need higher doses and take them for thirty years...I also don't know if they can damage the "tone" of the colon (cathartic colon?). This is what one of my gastroenterologists told me. Have you tried combining Amitiza and Zelnorm together? If not, I strongly suggest you try it before enbakring on laxative or enema use.Another idea -- combining Zelnorm and/or Amitiza with Miralax, Lactulose or Magnesium. Most often it's a combination of things that work, and this take a lot of time and patience to discover what it is. Sometimes it drives me crazy.Dana


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## CinNJ (Mar 6, 2004)

Thanks for the response! I do take Zelnorm and Amitiza. And I take magnesium and miralax as well! I've been trying docusate sodium but that doesn't seem to do much. I've upped fiber (flax and coconut flour) and consume plenty of water. Also take omega 3s, pantothenic acid, etc.I avoid things like lactulose because I have a ton of LG - and that will make it worse I think.I've had C problems since I was a kid - others in my family have the same thing. It sucks!


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## Kathleen M. (Nov 16, 1999)

There is a certain amount of debate, and it is hard to know for sure.It may just be that some people's constipation just keeps getting worse and worse and would have without the stimulatory laxatives.On the other hand there do seem to be people who abuse them and can eventually wean off and depending on the situation may have things get better.My sense is that most people using normal doses semi-regularly probably won't run into too much trouble. However if you start getting on the increasing dose cycle you could cause problems. After all, it is fairly common to hear people with eating disorders that often include very large doses of laxatives to have problems. How much is just the disordered eating mucked up the system by itself is hard to know (after all a lot of people on the show Survivor have problems when they first start eating regularly again).I'd avoid daily use, and if the dose stops working, do not increase it.Have they ever tested the pelvic floor to make sure it works or run a sitz marker test to see how fast stuff moves?K.


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## 15050 (Feb 28, 2007)

I have been taking senokot granules for 30 years. I never have a BM without it. When I was 20 years old I started having terrible c. issues. Went to a gastrologist and he suggested I use the senokot once a week, or every few days if I didn't have a bm. Said it wouldn't hurt me. Over the years, I have increased only a little bit, but I started with relatively high doses. I have been to several gastrologists since then and the sitz marker test indicated colon inertia. I take the senna every 4 days or so, and that's the extent of my BMs. Two years ago I started having GERD problems for the first time in my life, and after an endoscopy. I was diagnosed with Barretts Esophagus. I really think it all relates to the constipation. Anyway, I'm not sure if the senna has made the c. worse over the years, but my advice would be to try everything else before using it regularly. The specialists I've gone to recently told me they don't believe the senna caused my problems; it's been a lifelong issue and I had the sitz marker test only a couple years after starting the senna. Anyway, it's this or have my colon removed, and sometimes that seems possibly a better option....depending on how well the senna works.


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## flux (Dec 13, 1998)

> quote:There is a certain amount of debate, and it is hard to know for sure.


At the last AGMD conference, someone posed this question to the expert panel, Dr. Richard McCallum answered with everyone else in seeming agreement that the "debate" is over and that laxatives in general do not hurt the colon or make the existing problem worse. Dr. Michael D. Levitt also separately told me that Miralax is the safest laxative and can't hurt you. (Disclaimer: Dr. Levitt was a consultant to the company that makes it.)


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## Kathleen M. (Nov 16, 1999)

I've always said the osmotics like Miralax are safe.







I do think the the stimulatory laxatives at regular dose are generally safe. I just don't know if we can be certain that people who seriously abuse them (like people who take them a whole boxful at a time) can't possibly hurt themselves.Thus the "in general" in the statement you quote.I still think that if the usual dose doesn't work you probably shouldn't keep increasing the dose as most things that are safe at the recommended dose may cause problems at very high doses (after all first rule of toxicology, the dose makes the poison).That some on the board that have seriously abused laxatives due to eating disorders seem to have long term problems (anecdotal I know) even after they get well worries me about anyone using excessive amounts of them.Unfortunately people hear "safe" and figure if a little is good more is better, and that gets people into trouble as "safe" at recommended doses doesn't mean "safe" at every possible dose.K.


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## 16636 (Sep 29, 2006)

My question is what is the recommended dose of a laxative?If a person needs to take laxatives every day to have a BM, than it seems likely that even if you don't take a whole box, you're still taking too much (via taking it too often.) Right? So for those of us with chronic constipation or IBS-C who need daily therapy of some kind, stimulant laxatives aren't going to be a good choice. This is how it appears to me?Dana


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## Kathleen M. (Nov 16, 1999)

It looks the the recommended dose for one time use on the box used daily isn't the problem with modern laxatives that they think it is.Most of this is hold over from one of the banned stimulatory laxatives, and I don't know if we know how serious it was or not for damaging the colon.There are different rules IMO for people with chronic illnesses so you can't always apply the "for acute problem" rules to a chronic problem.You wouldn't tell someone with arthritis that has severe pain every day not to take their pain meds every day because if you just had surgery they only let you take pain meds for 2 weeks.If you are never normal without medication, then you need medication all the time.If you don't need something all the time, don't take it all the time.We see the same problem in reverse for IBS-D people and Imodium. If you have an acute illness and you still need it after a few days you are supposed to see the doctor, not just keep taking Imodium. However once they know you have chronic diarrhea (whatever is the cause of it as many things cause chronic diarrhea) you don't need to go to the doctor every week to get a stool sample tested to find out why you have diarrhea this week. It is the same answer as last week, last month, last year, last decade.Anywho, all the recent info and the info the experts at the meetings say indicate it is safe with the senna and stuff on the market at the doses on the box for short term relief.K.


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## lorilou (May 9, 2003)

so am I right to conclude that stimulant is ok for short term but not long term for us chronic c people who need meds every day just to go?its been along day and Im pooped and the ol brain isnt fully working...


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## Kathleen M. (Nov 16, 1999)

The evidence seems to be that at normal doses (what someone would use for a day) every day isn't harmful, at least with the stuff you can buy OTC these days.About the only thing is do you care what color your colon lining is?Senna and some others can darken the lining, but I did find one paper on chronic consiptation that showed that darkening was unrelated to the problems causing the constipation (people with detectable nerve damage in the colon wall).They used to think if it could cause the color issue it was messing up other things, but that really seems to be only for the now banned stimulatory laxatives.K.


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## 14171 (Mar 10, 2007)

> quote:Originally posted by flux:
> 
> 
> > quote:There is a certain amount of debate, and it is hard to know for sure.
> ...


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## 14171 (Mar 10, 2007)

Miralax is the only laxative that works for me without causing problems like partial evacuations with diarrhea. I have been using it 1-2 times/day for 7 days and tried to stop but felt a little constipation returning. I am also taking acacia soluable fiber and eating lots of soluable fiber foods. Curious about the longterm effects or possible rebound effects of miralax. anyone know?


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