Purge and Purgatives: What they are and Side Effects

. Traditionally, the term has been reserved for remedies with an intermediate "intensity of action" between the milder ones (laxatives) and the so-called cathartic or drastic purgatives.

Shutterstock

This classification is scarcely used today, as very often the intensity of the effect depends more on the dose administered than on the intrinsic activity of the drug. In light of all these considerations, the term purgative is increasingly used as a simple synonym for laxative .

The indications in favor of the purgatives are limited; in most cases, constipation can be corrected simply by increasing the intake of liquids and fibers, and by intensifying physical exercise.

When stubborn constipation is due to important underlying causes - such as anorectal pathologies (hemorrhoids, fissures, rectocele, etc.), nervous diseases, drugs or functional pathologies affecting the intestine (colitis, diverticulitis, etc.) - it is necessary to focus on the treatment of the causes rather than on the symptom constipation.

The purgatives, therefore, become necessary only on a few occasions, including the preparation for particular diagnostic or surgical procedures, the prevention of efforts for defecation and softening of the stool (for example in the presence of hemorrhoids or in the post-heart attack).

The occasional ingestion of a purgative should not be demonized, but its habitual or frequent use must be condemned, which can lead to addiction phenomena or serious side effects, especially when it is the result of self-prescription which, in principle, should not be done .

, since a purge can produce the desired laxative effect through multiple actions.

GUY ACTION MECHANISM EXAMPLES

Lubricating purgatives

They lubricate the fecal mass and the walls of the intestinal lumen. The time of "onset of action" is around 6-8 hours. Vegetable oils (sweet almond oil), petroleum jelly or liquid paraffin.

Irritating purgatives, stimulants

Active, irritating or toxic ingredients, which abnormally stimulate intestinal motility and secretion. The evacuation of faeces is thus accelerated. Generally it is advisable to take them in the evening before going to bed since they have a latency of effect of about 6 - 8 hours. They are the largest group of purgatives and include all anthraquinone drugs (senna, aloe - no longer usable - rhubarb, buckthorn, cascara), castor oil, bisacodyl, sodium picosulfate.

Mechanical purgatives

They retain water in the stool, increasing its volume and causing a mechanical distension of the colon which favors its motility. The effectiveness of these compounds is not immediate and it may take up to a few weeks of therapy before their effects can be appreciated. Fibers (bran, psyllium, linseed, mucilage, methylcellulose, glucomannan, polycarbophil, etc.). The use of fibers must always be accompanied by adequate water intake, otherwise the symptoms will worsen.

Osmotic purgatives

They increase the osmotic pressure in the intestine, drawing water from the tissues towards the inside of the enteric lumen. The result is rapid: poltaceous stools of greater volume or of a frankly watery consistency can be eliminated already after 5 or 6 hours from the intake, or 2-3 hours in the case of cathartic dosages widely used in order to empty the intestine before surgical interventions, radiological and endoscopic examinations.

Sodium sulfate; magnesium sulfate; magnesium hydroxide; sodium and potassium tartrate; some laxative foods, such as tamarind, cassia, and prunes.

Lactulose, lactose, sugar alcohols (sorbitol, mannitol, glycerol), polyethylene glycol.

Update: New European Regulation of 18 March 2021

On April 8, 2021, the ban on marketing foods and food supplements containing hydroxyanthracenes and their derivatives, a family of molecules contained in various plants, such as aloe, cassia, rhubarb and senna, came into force.

More in detail, the new European Regulation of March 18, 2021 - which came into force, precisely, April 8, 2021 - modifies Annex III of Regulation (EC) No. 1925/2006 of the European Parliament and of the Council to as regards the botanical species containing hydroxyanthracene derivatives.

The full text can be consulted by clicking here. However, we can summarize the main points as follows:

• The following are added to the list of substances whose use in food is prohibited (Annex III part A of the aforementioned regulation):
  • Aloe-emodin and all preparations in which this substance is present;
  • Emodin and all preparations in which this substance is present;
  • Preparations based on leaves of Aloe species containing hydroxyanthracene derivatives;
  • Dantrone and all preparations in which this substance is present.
• The following are added to the list of substances whose use in food is subject to Community surveillance (Annex III part C):
  • Preparations based on the root or rhizome of Rheum palmatum L., Rheum officinale Baillon and their hybrids containing hydroxyanthracene derivatives;
  • Preparations based on leaves or fruits of Cassia senna L. containing derivatives of hydroxyanthracene;
  • Preparations based on bark of Rhamnus frangula L. o Rhamnus purshiana A.D. containing derivatives of hydroxyanthracene.

, to avoid hardening of the stool which could lead to intestinal obstruction and aggravation of constipation. Subjects with ulcers, strictures or gastrointestinal adhesions should avoid their use. Gastric swelling, meteorism, flatulence and abdominal tension are the most common symptoms of overdose. Many of these substances interfere with numerous drugs, limiting their absorption; psyllium can cause IgE mediated allergic reactions.

The side effects of saline osmotic laxatives (magnesium sulfate, magnesium hydroxide and sodium salts) derive from the fact that a small percentage of the salts is still absorbed into the systemic circulation, causing more or less marked hydro-electrolytic imbalances. In this regard, hypertonic solutions are the most dangerous, especially for newborns and patients with kidney problems and hypertension. Polyethylene glycol, on the other hand, is generally well tolerated because it does not alter the patient's hydroelectrolytic balance.

Castor oil can cause damage to the intestinal mucosa, stimulate uterine contractions (contraindicated in pregnancy) and in the long term cause malabsorption. Vaseline oil can irritate the rectum and anal sphincter, and - if used for a long time - can cause malabsorption of fat-soluble vitamins.

The prolonged use of stimulant laxatives can lead to a deterioration of intestinal function, making the colon muscles more and more spastic and unable to contract. The abuse of anthraquinolones can cause melanosis of the colon.

Finally, we remind you that after an "energetic defecation induced by purging, a time interval of a few days is necessary before the waste necessary for a subsequent defecation accumulates in the intestinal tract. This condition of false constipation should absolutely not be understood as an anomalous phenomenon. and in no way justifies a new intake of purgatives.

;

Limit stress as much as possible or find a way to release accumulated tensions;

Follow a balanced high-residue diet (rich in plant foods and whole grains);

Chew your food carefully;

Eat meals at regular times (breakfast included);

Limit alcohol

Take large quantities of fluids distributed throughout the day;

During the "evacuation, take a" squat "position placing a rise under the feet in order to bring the thighs closer to the chest;

Try to resort to purging and laxatives as infrequently as possible and do so only after consulting your doctor;

If necessary, begin with the volume laxatives, lighter but with a slower action;

If frequent use of purgatives is necessary, consult a specialist.