• Where a rapid bowel evacuation is required,
magnesium sulphate is still used.
• This should be used in a dose before breakfast or on
an empty stomach, followed by plenty of warm
• This treatment usually causes evacuation within 2
Magnesium sulphate (MgSO4) Epsom salt
• MgSO4 dissociate into Mg & SO4. This Mg draws
water from intestine causing softer stool & help in
• MgSO4 is usually given in empty stomach
It may cause uremia in patients with renal
• It is a semi synthetic disaccharide of fructose &
• Taken orally, it is unaffected by small intestinal
disaccharidase, is not absorbed
• In the colon, bacteria convert it to its two
component sugars, which are poorly absorbed;
when these are fermented, the lactic acid & acetic
acid are formed which function as osmotic
laxatives. It takes 2-3 days to act
• Side effects: flatulence, cramps, & abdominal
• Dose: expressed in terms of an eoral solution
containing lactulose 3.35 g/5ml
• Constipation, adults initially 15 ml twice daily,
gradually reduced according to patients needs; child
under 1 year 2.5 ml, 1-5 years 5 ml., 6-12 years 10
ml twice daily, gradually reduced
• Hepatic encephalopathy, 30-50 ml 3 times daily,
subsequently adjusted to produce 2-3 soft stools
• Avolac (solution, 3.35 mg/5ml), D-Lac (syrup),
Laclose (syrup), Osmolax (syrup)
• Indication: mild constipation (acts in 2-4 hours)
• Caution: use only occasionally; the elderly; renal
impairment; hepatic impairment
• Contraindication: intestinal obstruction
• Dose: Aqueous suspension containing about 8%
hydrated magnesium oxide, 25-50ml as & when
• Magna milk, milk of magnesia (susp 400 mg/5ml)
Softening the stool by↓ surface tension of
stool which allows more water to remain in
It has bowel stimulant property.
↑ Intestinal fluid secretion, It mix with stool
& stool become soft.
• Chemically inert mineral oil
• Not digested
• Lubricates the intestinal wall
• Easy & increase rate of passage of gut contents
• Reduce absorption of water in the small intestine
• Retain more water in the gut contents
• Softening of the stool
• Easy evacuation
• Side effects :
Anal leakage following large doses of paraffin cause
physical & social discomfort.
Granulomatous reactions caused by absorption of
small quantities of liquid paraffin (especially from
Lipoid pneumonia (taken orally for long period,
especially at night, may be aspirated & cause
chronic lipoid pneumonia)
• Most strong laxatives
• Induces low grade inflammation in small &
large intestine to promote accumulation of
water & electrolyte
• Stimulate gut motility.
- Stimulant empty the whole colon. But normal
defecation only empties the descending colon .
-Cessation of use after a few weeks is followed by a
few days constipation to collect significant
materials to restore the normal state.
-This delay may convince the patient to continued
need for purgatives.
containing 130 ml of arachis oil (ground-nut
oil) would lubricate & soften impacted faeces
& promote bowel movement.
• For children above 6 years, the dose has to be
reduced in proportion to body-weight; not
recommended for children under 6 years
• It is the anatomical and physiological changes
in the colon that occurs with chronic use of
stimulant laxatives.(> 3times/weeks) for 1 yr
Feeling of fullness
Incomplete fecal evacuation
• Typically female patient.
• Long standing H/O laxative use
• Cause damage to the colonic Nerve.
• Rx – surgery.