Constipation

An alternative to osmolaxants are the bowel-stimulating laxatives sodium picosulphate (e.g. Laxoberal®) and bisacodyl (e.g. Dulcolax®). In the case of bisacodyl, PTA should point out that a time interval of at least one hour should be observed before taking milk or antacids. Otherwise, the protective coating of the laxative could already decompose in the stomach and irritate the stomach lining. Bisacodyl takes effect about six to eight hours after ingestion, sodium picosulphate ten to twelve hours. To be able to go to the toilet in the morning, patients should therefore take the drugs in the evening. One advantage of sodium picosulphate: the active ingredient is also available in liquid form. The drops are particularly suitable for patients who have difficulty swallowing solid medicines or need a flexible dosage.

Saline laxatives such as Glauber’s salt (Na2SO4) or Epsom salt (MgSO4) should, in the case of chronic constipation, be used with caution. Although they are effective, they may cause long-term adverse effects such as an electrolyte imbalance. If patients want a rektal emptying aid, PTA can recommend bisacodyl suppositories (e.g. Dulcolax® suppositories), glycerol suppositories (Glycilax® suppositories) or CO2-releasing suppositories (Lecicarbon®). If a monotherapy does not give the patient sufficient relief, preparations with different modes of action can be combined, such as bisacodyl and macrogols.

Patients who have concerns about a long-term treatment can be reassured by PTA: When applied as directed, prolonged use of laxatives is not dangerous. There are neither habituation effects and dose increases, nor potassium losses or any other serious side effects. The remedies improve well-being and can, should the worst case occur, protect against serious complications such as intestinal obstruction. However, they should not be used daily or prophylactically, but only as needed.