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At least 19 recordsLinked to original sources
PubMed1999

Use of laxatives in institutions for the mentally retarded.

OBJECTIVE: To study, in institutionalized mentally retarded patients, the prevalence of regular laxative use, and to identify its correlates. METHODS: Twenty-one of the 22 institutions for the mentally retarded in Flanders (Belgium) provided the setting for the study, which included a population of 3712 residents with an IQ of < 50. This was a descriptive cross-sectional study of a random sample of 20 patients per institution, consisting of a structured interview of the personnel responsible for daily care of the selected patients. The study population consisted of 420 mentally retarded patients. Their median age was 29 years (range 2-72 years). Twenty-six percent of patients had an IQ of 35-49, 40% an IQ of 20-34 and 34% an IQ of <20. Sixteen percent of the patients were non-ambulant. RESULTS: Regular laxative use was found in 26.4% (111/420) of the residents. In addition, occasional laxative use was found in 2% (10/420) of the residents. Oral laxatives were used daily by 13% (56/420) and oral laxatives daily in combination with enemas were used by 9% (39/420). Enemas but no oral laxatives were used by 3% (11/420); manual evacuation in combination with oral laxatives and enemas was used by 1% (5/420). Seventy-eight percent (78/100) of the oral laxative users used them for more than 1 year. Seventy-one percent (71/100) used one laxative, 23% two and 6% three. Thirty different brands of oral laxatives were used. Sixty-seven percent (67/100) used osmotic laxatives alone or in combination, 30% used stimulant laxatives, 19% used bulk forming laxatives and 19% mineral oil. Oral laxatives were always prescribed by attending physicians, while enemas were also initiated by nurses in 35% (18/52). Laxative use was positively and independently correlated with female gender, with being non-ambulant, with oral motor dysfunction and with the use of medication other than laxatives. It did not correlate with age. Within the institutions, laxative use varied from one to 15 users out of the 20 randomly selected patients (median 4/20). CONCLUSION: Laxative use is frequent in institutions for the mentally retarded, with a large inter-institution variation, indicating that constipation is an important problem and underlining the need for research into cost-effective treatment.

Adolescent↗
PubMed2003

Constipation--modern laxative therapy.

It is estimated that one third of the population in Western industrial countries suffers from constipation at least from time to time. Constipation may have somatopathic or functional causes. Furthermore, a great number of substances are known to cause medication-induced constipation, i.e. opioid-induced constipation is caused by linkage of the opioid to opioid receptors in the bowel and the central nerve system. Whenever possible, causal therapy should be undertaken. Patients in palliative care mostly suffer from chronic functional constipation. The treatment consists of basic measures and the application of laxatives. According to their mode of action, they are divided into bulk-forming laxatives, osmotic laxatives, stimulant laxatives, lubricating agents and others. Bulk-forming laxatives are not recommended for use in palliative care patients, for such patients are normally not able to take in the required amount of fluids. Osmotic laxatives are divided into (magnesium) salts, saccharine, alcohols and macrogols. Lactulose is the most popular saccharine laxative. Because of its side effects (flatulence, bloating and abdominal cramping), lactulose is not a laxative of our choice; instead, we prefer to give macrogol. Orally administered, macrogol is not metabolised and pH value and bowel flora remain unchanged. Macrogol hydrates hardened stools, increases stool volume, decreases the duration of colon passage and dilates the bowel wall that then triggers the defecation reflex. Even when given for some time, the effectiveness of macrogol will not decrease. Because of its high effectiveness and commonly good tolerance, macrogol has become the laxative of first choice in palliative care patients with all kinds of chronic constipation, if these patients are able to take in the necessary amount of fluids. From the general medical point of view, lubricating agents have become obsolete. In palliative care patients, however, they are still important laxatives for prophylactic treatment or therapy of constipation. Due to clinical experience, in palliative care a laxative ladder has proven successful.

Aged↗
PubMed1995

Correlates of regular laxative use by frail elderly persons.

PURPOSE: To examine the demographic, clinical, and pharmacological correlates of regular laxative use in elderly persons residing in a long-term care setting. METHODS: This was a cross-sectional study using retrospective record review undertaken in an academically affiliated long-term care facility in the United States. All individuals residing in the institution for at least 1 month (n = 694) were characterized regarding use of laxatives. Regular laxative use was defined as more than 30 doses of laxatives, stool softeners, or enemas taken over the most recent 1-month period. RESULTS: Residents with regular laxative use (n = 349) were compared with those who received no laxatives (n = 227). Factors significantly associated with regular laxative use at the P < 0.05 significance level were simultaneously included in a multiple logistic regression model. Factors associated with regular laxative use were immobility, Parkinson's disease, diabetes mellitus, and use of iron supplements, calcium channel blockers, and antidepressants with moderate to strong anticholinergic properties. CONCLUSION: Regular laxative use is often associated with neurologic dysfunction that directly or indirectly affects the gut, or medications known to depress colonic motility. Identification of potentially modifiable correlates of regular laxative use in older individuals may suggest management strategies to avoid or reduce laxative, stool softener, and enema requirements, improve constipation symptoms, and enhance quality of life for the frail elderly population.

Aged↗
PubMed2002

Laxative prescribing in relation to opioid use and the influence of pharmacy-based intervention.

INTRODUCTION: Opioid-induced constipation is a common problem and can cause serious complications. It is widely advised that laxatives should be started concurrently with opiates, unless there is a clear indication not to do so. OBJECTIVE: This study was undertaken to estimate how often laxatives were started concurrently with opiates and to describe the effect of pharmacy-based interventions to promote the use of laxatives in patients starting opioids. METHODS: Twenty-six community pharmacies identified all patients who received a first prescription for a strong opioid during January and February of 1998, 1999 or 2000. Pharmacists collected information on patient, drug and prescriber characteristics (age, gender, use of opiates and laxatives). A separate questionnaire was used to collect data on pharmacy-based interventions to promote the simultaneous prescribing of laxatives with the opiates. RESULTS: Overall, 37% of the patients receiving an opioid started taking laxatives within 5 days. The percentage of patients who received laxatives simultaneously with opioids increased from 31% in 1998 to 35% in 1999 and 42% in 2000. In 117 (43%) of the opioid prescriptions, pharmacy-based intervention had taken place before the prescription date. Of these, 48.7% was accompanied by a laxative. Opioid prescriptions (n=152) without a pharmacy based intervention were accompanied in 27.6%. After adjustment for covariates (including time trends), pharmacy-based intervention increased the probability of concomitant laxative use 1.9 [95% CI 1.1-3.3] times. DISCUSSION: This study shows that the widely used guideline to start a laxative when prescribing an opioid is not always followed in daily practice. In addition, we showed that pharmacy-based intervention contributed to increasing laxative use in patients receiving opioids.

Aged↗
PubMed2000

Detection and importance of laxative use in adolescents with anorexia nervosa.

OBJECTIVE: The frequency of laxative use in adolescents with anorexia nervosa is poorly described. This study of adolescents with anorexia nervosa examined self-report and biochemical screening methods for the detection of laxative use, the pattern of laxative use in this population over time, and the associated medical complications and psychopathology. METHOD: Forty-three consecutive patients with anorexia nervosa were studied. Initial assessment encompassed psychiatric history, medical examination, and administration of the Eating Disorders Examination, Child Behavior Checklist, and Youth Self-Report. Biochemical investigations, including random urinary laxative screening, were performed at assessment and follow-up. RESULTS: The frequency of laxative use from self-report alone was 12%; combined with urine screening it was 19%. The frequency of laxative use increased to 32% with prospective follow-up. Medical complications were associated with laxative use at follow-up. Laxative use was associated with longer duration of disease and with higher scores on the Eating Disorders Examination subscale Eating Concern. CONCLUSIONS: Laxative use is common among adolescents with anorexia nervosa, and the risk of associated medical complications increases over time. Biochemical screening will improve detection of laxative use. Longer duration of illness and greater Eating Concern scores are associated with increased risk of laxative use, and monitoring patients at increased risk is important.

Adolescent↗
PubMed1994

Use of laxative medication in older persons and associations with low serum albumin.

OBJECTIVE: To study laxative use among older persons and the association of laxative intake with hypoalbuminemia. DESIGN: Cross-sectional study in a population-based cohort. SETTING: Community and institutions in the Iowa and Washington counties, Iowa site of the Established Populations for Epidemiologic Studies of the Elderly. PARTICIPANTS: Persons aged 71 years or older, who were interviewed at the 6th year of follow-up and for whom drug intake information was obtained (n = 2,529). MAIN OUTCOME MEASURES: Laxative medication use and prevalence of hypoalbuminemia. RESULTS: The prevalence rate of laxative use was 8.8% in the community and 74.6% in nursing homes. Increasing age was independently associated with laxative use (odds ratio [OR] = 1.66, 95% confidence interval [CI] = 1.33 to 2.07 for a 10-year increase), after adjusting for gender, institutionalization, disability in activities of daily living, body mass index, and use of the following drugs: furosemide, benzodiazepines, antidepressants, codeine, and calcium antagonists. Laxative use was independently associated with hypoalbuminemia (OR = 3.17, 95% CI = 1.42 to 7.08) after adjusting for age, gender, anemia, number of comorbid conditions, disability in activities of daily living, body mass index, use of furosemide, and institutionalization status. Compared with those who never used laxatives, those who took laxatives only at the 6th year of follow-up were at increased risk of hypoalbuminemia (OR = 2.65, 95% CI = 1.04 to 6.77), and those who used laxatives at both the 3rd and 6th years of follow-up were at greatest risk (OR = 4.02, 95% CI = 1.53 to 10.06). CONCLUSION: Laxatives are used by large numbers of older persons, and the investigation on unknown adverse effects is important. Prospective studies are needed to confirm the association of laxative use with hypoalbuminemia found in this study and to assess the mechanisms of this association.

Activities of Daily Living↗
PubMed1996

Laxative abuse among women with eating disorders: an indication of psychopathology?

OBJECTIVE: The results of the scant research on laxative abuse among women with eating disorders suggest that laxative abuse is a diagnostic indicator of greater psychopathology. We further investigated the relationship of history of laxative abuse to eating and related attitudes, impulsivity, and personality pathology. METHOD: Women assessed in an outpatient clinical setting and diagnosed with anorexia nervosa, binge-eating/purging type (n = 51) or bulimia nervosa, purging type (n = 280) completed measures of laxative abuse, eating and related attitudes, and personality psychopathology at intake. RESULTS: More than one-half of both groups had abused laxatives at some point. History of laxative abuse was unrelated to eating disorder diagnostic category, current age or body weight, history of stealing, self-induced injury, having attempted suicide, interpersonal distrust, maturity fears, or compulsive or dependent personality features. Compared to nonabusers, laxative abusers demonstrated more perfectionism and avoidant personality features. Significant statistical interactions among variables revealed that bulimia nervosa patients who had abused laxatives exhibited the most pathological scores on scales measuring drive for thinness, body dissatisfaction, ineffectiveness, lack of interoceptive awareness, and passive-aggressive and borderline personality features. Anorexia nervosa patients who had abused laxatives had the highest scores on the histrionic scale. DISCUSSION: Results are discussed with regard to past research and clinical implications. We propose that laxative abuse among eating disordered women may serve different functions depending on diagnosis and underlying personality dynamics.

Adolescent↗
PubMed1995

Effect of three laxatives and a cation exchange resin on fecal sodium and potassium excretion.

BACKGROUND/AIMS: The treatment of hyperkalemia in patients with renal insufficiency often includes the ingestion of sorbitol and a cation exchange resin. Sorbitol alone may be used to remove sodium and water from overloaded patients. The efficacy of these regimens has never been compared with other laxative or laxative-resin combinations. The aim of the study was to compare the relative effect of three laxatives with different mechanisms of action, alone and in combination with resin, on fecal sodium and potassium excretion. METHODS: Sodium, potassium, and water excretion in 12-hour stool collections were analyzed after various laxative-resin combinations in normal subjects. RESULTS: Correctol (yellow phenolphthalein) (Schering Plough Health Care Products, Memphis, TN) was more effective than sorbitol or sodium sulfate in causing fecal sodium and potassium loss. Resin recovery in stool was much greater with phenolphthalein than with other laxatives, and more potassium was excreted in stool with phenolphthalein-resin than with phenolphthalein alone or other laxative-resin combinations. Sorbitol caused more undesirable gastrointestinal symptoms than did sodium sulfate or phenolphthalein. CONCLUSIONS: In normal people, phenolphthalein (1) is preferable to other laxatives in causing fecal sodium and potassium excretion, (2) hastens resin transit through the intestine compared with other laxatives, and (3) produces greater fecal potassium excretion when combined with resin than phenolphthalein alone or other laxative-resin combinations.

Cathartics↗
PubMed1998

Alterations in colonic anatomy induced by chronic stimulant laxatives: the cathartic colon revisited.

Cathartic colon is a historic term for the anatomic alteration of the colon secondary to chronic stimulant laxative use. Because some have questioned whether this is a real entity, we investigated changes occurring on barium enema in patients ingesting stimulant laxatives. Our study consisted of two parts. In part 1, a retrospective review of consecutive barium enemas performed on two groups of patients with chronic constipation (group 1, stimulant laxative use [n=29]; group 2, no stimulant laxative use [n=26]) was presented to a radiologist who was blinded to the patient group. A data sheet containing classic descriptions of cathartic colon was completed for each study. Chronic stimulant laxative use was defined as stimulant laxative ingestion more than three times per week for 1 year or longer. To confirm the findings of the retrospective study, 18 consecutive patients who were chronic stimulant laxative users underwent barium enema examination, and data sheets for cathartic colon were completed by another radiologist (part 2). Colonic redundancy (group 1, 34.5%; group 2, 19.2%) and dilatation (group 1, 44.8%; group 2, 23.1%) were frequent radiographic findings in both patient groups and were not significantly different in the two groups. Loss of haustral folds, however, was a common finding in group 1 (27.6%) but was not seen in group 2 (p < 0.005). Loss of haustral markings occurred in 15 (40.5%) of the total stimulant laxative users in the two parts of the study and was seen in the left colon of 6 (40%) patients, in the right colon of 2 (13.3%) patients, in the transverse colon of 5 (33.3%) patients, and in the entire colon of 2 (13.3%) patients. Loss of haustra was seen in patients chronically ingesting bisacodyl, phenolpthalein, senna, and casanthranol. We conclude that long-term stimulant laxative use results in anatomic changes in the colon characterized by loss of haustral folds, a finding that suggests neuronal injury or damage to colonic longitudinal musculature caused by these agents.

Aged↗
PubMed1987

The carry-over effect on the bowel habit in elderly long-term patients of long-term bulk-forming products containing stimulant laxative.

This study was undertaken to investigate the possible carry-over effect on elderly long-term patients of bulk-forming products containing stimulant type laxatives. Thirty-six patients received magnesium hydroxide daily for a mean period of 10 months prior to the study, and 23 patients received bulk laxatives containing cassiae senna daily for a mean period of 13 months prior to the study. The pre-study laxatives were randomly changed either to magnesium hydroxide or to bulk laxatives. In the patient group receiving a bulk-forming product containing stimulant type laxative long-term prior to the study, the need for additional stimulant laxatives during the pure bulk laxative (3.0 vs. 3.8/4 weeks, NS) or magnesium hydroxide treatment (2.6 vs. 2.7/4 weeks, NS) was not more frequent and the frequency of defaecation was not lower than in the patients (during bulk laxative 11.2 vs. 9.3/4 weeks, NS and during magnesium hydroxide 12.0 vs. 13.7/4 weeks, NS) who received long-term magnesium hydroxide treatment prior to the study. Thus, our data indicated no carry-over effect after the use of bulk-forming laxatives containing senna for 13 months in elderly long-term patients.

Aged↗
PubMed1995

Age and laxative use in hospitalized patients. A report of the "Gruppo Italiano di Farmacovigilanza nell'Anziano--GIFA".

Laxatives are frequently taken especially by older persons, who have multiple diseases and are disabled. Major differences exist among countries in the type of laxatives taken, and knowledge of the intake patterns is important because of the potential adverse effects associated with particular ingredients. Laxatives and factors related to their use are described in a sample of 3257 patients admitted to 58 hospitals of the Gruppo Italiano di Farmacovigilanza nell'Anziano (GIFA) in 1991. The mean age was 68.2 years, median 73 years, more than 30% were age > or = 80 years, and 48.7% were men. The overall prevalence rates of laxative use during hospital stay and prior to admission were 11.5% and 11.3%, respectively. Increasing age was independently associated with laxative use after adjusting for gender, activities of daily living, cognitive function, number of active medical problems, medications taken, Italian region and length of stay. After excluding the prescriptions for hyperammoniemia, lactulose was the most frequently taken laxative (prevalence: 6.7% during hospital stay and 4.3% prior to hospital admission), followed by anthranoid laxatives such as senna, cascara, rhein and aloe (1.9% in-hospital and 3.3% pre-hospital). Other less frequently taken laxatives were picosulfate, phenolphthalein, lactitol, glycerol, bisacodyl and docusate. These patterns differ substantially from those reported by surveys conducted in other countries. Further studies are needed to assess the risks and benefits related to the intake of specific laxative ingredients.

Age Distribution↗