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Chronic Megacolon Medication

  • Author: David Manuel, MD; Chief Editor: BS Anand, MD  more...
 
Updated: Mar 28, 2016
 

Medication Summary

A high water intake is an essential measure. A minimum of 6-8 8-oz glasses a day is recommended.

Bulking agents, through the increase of fiber, are also important. Many agents are on the market for this purpose and typically contain psyllium husk or cellulose; each patient may respond differently to each agent. No single agent is superior to another.

Laxatives may be considered and continued if found to be helpful. The best laxatives for this purpose are osmotic agents, such as magnesium salts, sorbitol, or lactulose (the latter two may increase flatulence). Patients need encouragement to take sufficient amounts to produce a result. Stimulant laxatives are best left as a last resort because they may possibly induce deterioration in the ability of the colon to evacuate. Typical stimulant laxatives are senna and bisacodyl-containing medications. Many patients take natural herbal laxatives; these typically contain cascara.

For more information, see the FDA MedWatch Product Safety Alert.

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Laxatives

Class Summary

Increase peristalsis of the intestine, reducing the time toxic substances remain in the lower GI tract.

Psyllium (Metamucil, Fiberall)

 

Promotes bowel evacuation by forming viscous liquid and perhaps by inducing peristalsis.

Magnesium hydroxide (Philips' Milk of Magnesia)

 

Causes osmotic retention of fluid, which distends the colon and probably increases peristaltic activity; promotes emptying of bowel.

Sorbitol

 

Hyperosmotic laxative that has cathartic actions in the GI tract.

Lactulose (Cephulac, Cholac, Constilac)

 

Produces osmotic effect in colon that results in distention and promotes peristalsis.

Senna (Senexon, Ex-Lax, Senokot, Senna-Gen, Black-Draught, Agoral)

 

Anthraquinone stimulant hydrolyzed by colonic bacteria into active compound. More potent than cascara sagrada and produces considerably more abdominal pain. Usually produces action 8-12 h after administration.

Bisacodyl (Bisac-Evac, Bisco-Lax, Dulcolax, Dacodyl)

 

Stimulates peristalsis, possibly by stimulating colonic intramural plexus. Alters water and electrolyte secretion, producing net intestinal fluid accumulation and laxation.

Cascara sagrada

 

Irritates intestinal mucosa, increasing rate of colonic motility and changes fluid and electrolyte secretion.

Polyethylene glycol (PEG) solution

 

For treatment of occasional constipation. In theory, less risk of dehydration or electrolyte imbalance with isotonic polyethylene glycol compared with hypertonic sugar solutions. Laxative effect generated because polyethylene glycol is not absorbed and continues to hold water by osmotic action through small bowel and colon, resulting in mechanical cleansing. In theory, less risk of dehydration or electrolyte imbalance with isotonic polyethylene glycol compared with hypertonic sugar solutions. The laxative effect is generated because polyethylene glycol is not absorbed and continues to hold water by osmotic action through the small bowel and the colon, resulting in mechanical cleansing. Supplied with measuring cap marked to contain 17 g of laxative powder when filled to the indicated line. May require 2-4 d (48-96 h) to produce bowel movement.

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Contributor Information and Disclosures
Author

David Manuel, MD Affiliate Faculty, Department of Medicine, Loyola University Health System; Gastroenterologist, Digestive Health Center

David Manuel, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Medical Association, American Society for Gastrointestinal Endoscopy, Crohn's and Colitis Foundation of America

Disclosure: Nothing to disclose.

Coauthor(s)

Clifford Y Ko, MD, MS Professor, Department of Surgery, University of California, Los Angeles, David Geffen School of Medicine

Clifford Y Ko, MD, MS is a member of the following medical societies: American College of Surgeons, American Medical Association, American Society of Colon and Rectal Surgeons, Association for Academic Surgery, California Medical Association, New York Academy of Sciences

Disclosure: Nothing to disclose.

Michael H Piper, MD Clinical Assistant Professor, Department of Internal Medicine, Division of Gastroenterology, Wayne State University School of Medicine; Consulting Staff, Digestive Health Associates, PLC

Michael H Piper, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Gastroenterology, American College of Physicians, Michigan State Medical Society

Disclosure: Nothing to disclose.

Roberto M Gamarra, MD Consulting Gastroenterologist, Digestive Health Associates, PLC

Roberto M Gamarra, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Medical Association, American Society for Gastrointestinal Endoscopy, Crohn's and Colitis Foundation of America

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Douglas M Heuman, MD, FACP, FACG, AGAF Chief of Hepatology, Hunter Holmes McGuire Department of Veterans Affairs Medical Center; Professor, Department of Internal Medicine, Division of Gastroenterology, Virginia Commonwealth University School of Medicine

Douglas M Heuman, MD, FACP, FACG, AGAF is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Physicians, American Gastroenterological Association

Disclosure: Received grant/research funds from Novartis for other; Received grant/research funds from Bayer for other; Received grant/research funds from Otsuka for none; Received grant/research funds from Bristol Myers Squibb for other; Received none from Scynexis for none; Received grant/research funds from Salix for other; Received grant/research funds from MannKind for other.

Chief Editor

BS Anand, MD Professor, Department of Internal Medicine, Division of Gastroenterology, Baylor College of Medicine

BS Anand, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Additional Contributors

Terence David Lewis, MBBS, MBBS 

Terence David Lewis, MBBS, MBBS is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Medical Association, California Medical Association, Royal College of Physicians and Surgeons of Canada, Sigma Xi

Disclosure: Nothing to disclose.

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