The most prevalent type of constipation is known by the descriptor “idiopathic” or “functional”. The meaning of these words imply that the root cause is not known, but the condition is clearly diagnosed from its symptomatic effects. Often the first treatment is dietary fiber infusion. In the event that this is not effective (which is approximately 70% of cases), patients can try out medical laxatives.
The general consensus among physicians and researchers is that laxative constipation treatments is safe and well-tolerated. But given that some patients must take them over long periods of time, doubts have come up about both efficacy and long term, unintended consequences. A consequence of these doubts have been the appearance of what seems to be misconceptions concerning laxative usage.
There are three kinds of misconceptions about laxative usage. The first is the idea that long term use causes nerves in the gastrointestinal tract to be damaged. The second is the idea that long term use leads to higher chance of cancer. The third is that the gut starts to become “immune” to laxatives and perhaps suffer “rebound” effects that worsen constipation.
With respect to the first, reports first surfaced in studies on patients who had been using laxative constipation treatments for a long term. Studies of the colonic lining showed a discoloration. Follow-up showed that some had nerve damage. THe problem is that these studies were not well controlled with a placebo population. Critics say that patients with constipation already have higher predisposition to nerve damage. Later studies did not hold up the causal link between constipation medication and laxatives.
Regarding the second, studies linking laxatives to cancer came from animal experiments. Animals fed very high concentrations of an anthraquinone laxative showed higher mutations in the DNA. However this study was beset by the problem that the amounts fed were much higher than human doses. Therefore, extrapolation to human doses is not straightforward. The same kinds of study have shown that artificial sweeteners and peanut butter cause mutations, but only at very high concentrations that are not often seen in people.
On the topic of the third, informal reports from patients who said they were seeing diminished effectiveness from medication initiated the idea of laxative intolerance. The counterpoint to this is that controlled studies in both animals and quadraplegic patients who used laxatives for as long as 34 years did not suffer from intolerance effects.
It would seem that laxatives should not be discounted for their great utility against constipation because of these misconceptions. Patients should continue to research for themselves and ally with their doctors to understand the evidence concerning laxative efficacy.
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