Over-the-counter laxatives for constipation: Use with caution

Date Updated: 03/03/2022

If you've ever been constipated, you may have tried over-the-counter laxatives. A number of factors — including a poor diet, low fluid intake, physical inactivity and several medications — can disrupt normal bowel function and cause constipation.

Many safe, effective over-the-counter laxatives are available to treat occasional constipation in a variety of ways. However, it's very important to read the label directions carefully and to use them as directed. Overuse of laxatives may cause you to become dependent on them for a bowel movement.

Call your health care provider immediately if you have:

Severe abdominal cramps or pain
Unexplained changes in bowel patterns
Severe diarrhea
Bloody stools or rectal bleeding
Constipation that lasts longer than seven days despite laxative use
Weakness or unusual tiredness
Dizziness

Before trying laxatives

How often you have a bowel movement varies, but people normally have as many as three bowel movements a day to as few as three a week. You may be constipated if you have fewer bowel movements than are normal for you. In addition, constipation may involve stools that are difficult to pass because they're hard, dry or small.

However, before turning to laxatives, try these lifestyle changes to help with constipation:

Eat fiber-rich foods, such as wheat bran, fresh fruits and vegetables, and oats. The average adult should get 25 to 31 grams of fiber per day.
Drink plenty of fluids daily — about 8 to 10 glasses (8 ounces) of noncaffeinated, nonalcoholic beverages throughout the day.
Exercise regularly.

Lifestyle improvements relieve constipation for many people, but if problems continue despite these changes, your next choice may be a mild laxative.

How laxatives relieve constipation

Laxatives work in different ways, and the effectiveness of each laxative type varies from person to person. In general, bulk-forming laxatives, also referred to as fiber supplements, are the gentlest on your body and safest to use long term. Metamucil and Citrucel fall into this category.

Here are some examples of types of laxatives. Even though many laxatives are available over the counter, it's best to talk to your doctor about laxative use and which kind may be best for you.

Type of laxative (brand examples)	How they work	Side effects
Oral osmotics (Phillips' Milk of Magnesia, MiraLAX)	Draw water into the colon to allow easier passage of stool	Bloating, cramping, diarrhea, nausea, gas, increased thirst
Oral bulk formers (Benefiber, Citrucel, FiberCon, Metamucil)	Absorb water to form soft, bulky stool, prompting normal contraction of intestinal muscles	Bloating, gas, cramping or increased constipation if not taken with enough water
Oral stool softeners (Colace, Surfak)	Add moisture to stool to soften stool, allowing strain-free bowel movements	Electrolyte imbalance with prolonged use
Oral stimulants (Dulcolax, Senokot)	Trigger rhythmic contractions of intestinal muscles to eliminate stool	Belching, cramping, diarrhea, nausea, urine discoloration with senna and cascara derivatives
Rectal suppositories (Dulcolax, Pedia-Lax)	Trigger rhythmic contractions of intestinal muscles and soften stool	Rectal irritation, diarrhea, cramping

Oral laxatives may interfere with your body's absorption of some medications and nutrients. Some laxatives can lead to an electrolyte imbalance, especially after prolonged use. Electrolytes — which include calcium, chloride, potassium, magnesium and sodium — regulate a number of body functions. An electrolyte imbalance can cause abnormal heart rhythms, weakness, confusion and seizures.

Combination laxatives: Check labels carefully

Some products combine different types of laxatives, such as a stimulant and a stool softener. But combination products don't necessarily work more effectively than single-ingredient products. In addition, they may be more likely to cause side effects.

A single-ingredient laxative may work better for you. Read labels to make sure you know what you're taking, and use with caution.

Risks of laxative use

Interaction with medications. Your medical history and medications you're taking may limit your laxative options. Laxatives can interact with some antibiotics, and certain heart and bone medications. Read labels carefully. If you're not sure whether to try a particular laxative, ask your pharmacist or doctor. Don't exceed recommended dosages unless your doctor tells you otherwise.
Complicating conditions. Laxative use can be dangerous if constipation is caused by a serious condition, such as appendicitis or a bowel obstruction. If you frequently use certain laxatives for weeks or months, they can decrease your colon's ability to contract and actually worsen constipation.
Precautions for pregnant women and children. Don't give children under age 6 laxatives without a doctor's recommendation. If you're pregnant, ask your doctor before using laxatives. Bulk-forming laxatives and stool softeners are generally safe to use during pregnancy, but stimulant laxatives may be harmful.

If you've recently given birth, consult your doctor before using laxatives. Although they're usually safe to use during breastfeeding, some ingredients may pass into breast milk and cause diarrhea in nursing infants.

Take laxatives with caution

If you're dependent on laxatives to have a bowel movement, ask your doctor for suggestions on how to gradually withdraw from them and restore your colon's natural ability to contract.