30.3 Laxatives and Stool Softeners

Laxatives and stool softeners are crucial for managing constipation. They work in different ways, from bulking up stool to drawing water into the intestines. Understanding how each type functions helps choose the right one for specific needs.

Nurses play a key role in administering these medications safely. They must assess patients, monitor for side effects, and educate on proper use. This includes teaching about hydration, diet, and lifestyle changes to support digestive health.

Types and Mechanisms of Laxatives and Stool Softeners

Laxatives and stool softeners

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• Bulk-forming laxatives
  • Increase fecal mass by absorbing water and stimulate peristalsis through increased intestinal pressure
  • Psyllium (Metamucil), methylcellulose (Citrucel), polycarbophil (FiberCon) act as soluble fibers that form a gel-like substance in the intestines
• Osmotic laxatives
  • Draw water into the intestines by creating an osmotic gradient to soften stool and increase motility through increased intestinal pressure
  • Magnesium hydroxide (Milk of Magnesia), polyethylene glycol (MiraLAX), lactulose (Kristalose) are hyperosmolar agents that retain water in the colon
• Stimulant laxatives
  • Increase intestinal motility by stimulating the myenteric plexus and secretion of water and electrolytes into the intestinal lumen
  • Bisacodyl (Dulcolax), senna (Senokot), castor oil stimulate peristalsis and reduce water absorption in the colon
• Emollient laxatives (stool softeners)
  • Soften stool by increasing water penetration into the stool and decreasing surface tension of the stool
  • Docusate sodium (Colace) is a surfactant that allows water and fats to penetrate the stool more easily

Mechanisms, indications, and side effects

• Bulk-forming laxatives
  • Mechanism: absorb water to increase fecal mass and stimulate peristalsis through increased intestinal pressure
  • Indications: chronic constipation, irritable bowel syndrome, diverticular disease help regulate bowel movements and prevent straining
  • Side effects: bloating, flatulence, abdominal discomfort may occur due to increased gas production from bacterial fermentation
• Osmotic laxatives
  • Mechanism: create an osmotic gradient to draw water into the intestines, softening stool and increasing motility through increased intestinal pressure
  • Indications: acute and chronic constipation, preparation for bowel procedures (colonoscopy) help clear the bowels
  • Side effects: electrolyte imbalances (hypermagnesemia with magnesium-based laxatives), dehydration, abdominal cramping can result from excessive fluid loss
• Stimulant laxatives
  • Mechanism: stimulate intestinal motility by activating the myenteric plexus and secretion of water and electrolytes into the intestinal lumen
  • Indications: acute constipation, preparation for bowel procedures (surgery) provide rapid relief of constipation
  • Side effects: abdominal cramping, diarrhea, electrolyte imbalances, melanosis coli (darkening of the colon mucosa with long-term use) can occur due to overstimulation
• Emollient laxatives (stool softeners)
  • Mechanism: decrease surface tension of the stool and allow water to penetrate more easily, softening the stool
  • Indications: prevention and treatment of constipation, hemorrhoids, anal fissures help reduce straining during bowel movements
  • Side effects: abdominal cramping, diarrhea, electrolyte imbalances (rare) may occur with excessive use

Nursing Considerations and Patient Education

Nursing considerations

• Assess patient's bowel habits, medical history (obstruction, impaction, inflammatory bowel disease), and current medications (opioids, anticholinergics) before administering to ensure appropriate selection and safety
• Monitor fluid and electrolyte balance, especially with osmotic and stimulant laxatives, to prevent dehydration and electrolyte abnormalities
• Encourage adequate fluid intake (8-10 glasses per day) to prevent dehydration and enhance laxative effectiveness by softening stool
• Provide privacy and ensure easy access to bathroom facilities to promote patient comfort and prevent accidents
• Monitor for adverse effects (abdominal pain, diarrhea, electrolyte imbalances) and report to the healthcare provider if necessary to adjust therapy
• Educate patients on proper use, potential side effects, and when to seek medical attention to ensure safe and effective use

Patient education plan

• Explain the purpose and mechanism of action of the prescribed laxative or stool softener to promote understanding and adherence
• Provide clear instructions on dosage, frequency (daily, as needed), and duration of use (short-term, long-term) to ensure proper administration
• Emphasize the importance of staying hydrated and drinking adequate fluids (water, clear liquids) to prevent dehydration and enhance laxative effectiveness
• Encourage a balanced diet rich in fiber (whole grains, legumes), fruits (prunes, apples), and vegetables (broccoli, carrots) to promote regular bowel movements and overall digestive health
• Advise patients to report any adverse effects (severe abdominal pain, bloody stools) or persistent constipation (no bowel movement for 3 days) to their healthcare provider for prompt evaluation and management
• Caution against long-term use of stimulant laxatives due to potential dependence and adverse effects (electrolyte imbalances, melanosis coli) and recommend gradual tapering under medical supervision
• Recommend lifestyle modifications, such as regular exercise (walking, yoga) and establishing a consistent bowel routine (going to the bathroom at the same time each day) to promote regular bowel movements
• Inform patients about non-pharmacological interventions, such as fiber supplementation (bran, psyllium) and abdominal massage (gentle circular motions) to enhance the effectiveness of laxatives and stool softeners