Medical stimulation and the regulation of stool consistency are often necessary in order to control defecation in people with spinal cord injury (SCI). Laxatives1 can be hazardous to health, although many of them are herbal. The principle is: as little as possible – as much as necessary.

Taking laxatives can induce a habituation effect – they are therefore not suitable for long-term use. Laxatives are chosen depending on how they work.

A normal stool consistency (formed stools) supports defecation. A balanced diet, including high-fibre grains and a sufficient fluid intake helps to regulate stool consistency; regular exercise also supports bowel movement.

Traditional domestic remedies – useful or not?

In the case of constipation problems, people tend to try remedies with natural ingredients first. However, they are often not appropriate for long-term use or suitable for people with spinal cord injury.

Senna pods

Many laxative teas, and sometimes also fig syrup, contain senna pods. However, sennas might reduce colon activity, lead to imbalances in intestinal fluid absorption and tend to be addictive.

Wheat bran, flax seed, psyllium, etc.

These food-based fibres are perfectly suitable for normal diets, but they are only somewhat appropriate for regulating stool movements in people with spinal cord injuries. They can be deposited in mucosal skin folds or diverticula2 of the colon and thus cause inflammations.

Measures to stimulate rectal defecation

All measures to support rectal defecation, as well as all oral laxatives, are drugs. Please read the package information leaflet carefully before using the product and contact your GP if you have any questions.

Suppositories

Two types of suppositories have proven to be effective in people with a spinal cord injury. They are both suitable for long-term application:

  • Suppositories which produce carbon dioxide (Lecicarbon®) stimulate peristalsis3 through the formation of gas bubbles, bringing about a stool movement. They take about 15 – 30 minutes to work.
  • Bisacodyl suppositories (Prontolax®, Dulcolax®) inhibit the absorption of water from the bowel and trigger peristalsis, enabling a stool movement to take place. They take 20 – 60 minutes to work.

Glycerine suppositories are not suitable for people with complete spinal paralysis because they only work in the rectum.

Enemas

Enemas withdraw fluid from the body. This leads to an increase in the stool volume in the large intestine, stimulating bowel activity. They contain either salts (Freka Clyss®) or sugar and sugar alcohol (Microklist®) as active agents. They take 5 – 20 minutes to work. They are unsuitable for long-term use and only used to relieve constipation.

Oral laxatives

Generally it is important to avoid taking laxatives whenever it is possible. The use of laxatives depends on the stool consistency. The effect usually starts after at least 24 hours. Oral laxatives are therefore not suitable for short-term use.

Oral laxatives work in different ways and can be put in different groups:

  • Swelling agents (Agiolax® mite, Metamucil® N Mite, Colosan® mite, etc.) swell when water is absorbed, increasing the volume of the stool and stimulating the bowel. This ensures that the stool has a soft, smooth consistency. It takes a relatively long time to work: anything from 12 hours to several days, depending on the product. They can be taken over a long period. It is important to drink plenty if you are taking swelling agents. Otherwise, you may become constipated.
  • Water-retaining agents produced from Macrogol and salts (Movicol®) or synthetic sugar (Importal Sachet®) retain water in the bowel, increasing the volume of the stool in the large intestine and stimulating bowel activity, as well as leading to the softening of the stool. The length of time it takes to work varies; about 12 – 48 hours in the case of synthetic sugar and 24 – 72 hours for salts. They can be taken over a long period.

Oral laxatives dehydrate our body. It is important to drink a lot of water in order to compensate for the loss of fluid.

Do I always need to consult a physician when making changes in the use of laxatives?

Not necessarily. If you know the respective drug and only want to change the dosage, you can do this without having to ask your physician. However, this comes with experience, which you will acquire over time.

In the case of problems, or if you are not satisfied with the dosage of your laxative, please contact your GP. It is not recommended to only consult a pharmacist, as laxatives often have different effects on people with SCI, compared to the effects they have on people without bowel paralysis. Therefore, not all drugs are suitable for people with SCI.

Do I have to take laxatives for the rest of my life?

That depends on your diet and the amount of exercise. Basically, the overall aim is to find the right balance for soft and smooth stools. This way the risk of haemorrhoids and anal fissures can be reduced – however, this is only possible for people without faecal incontinence.

If I have an artificial anus, is there anything I need to consider when choosing a laxative?

Yes – depending on what kind of artificial anus you have, not all drugs are suitable for you, as the effect of many products is restricted to the colon. We therefore recommend con-sulting your GP or an intestinal disease special-ist before choosing a laxative.

Do insurance companies pay for laxatives in Switzerland?

In most cases they don’t. Different insurance companies pay for different preparations – please ask your insurance company directly.

1 Purgative agents

2 Intestinal diverticulum

3 Bowel movements

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