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Medline ® Abstract for Reference 20

of 'Management of chronic constipation in adults'

Is chronic use of stimulant laxatives harmful to the colon?
Wald A
J Clin Gastroenterol. 2003;36(5):386.
Although stimulant laxatives cause structural damage to surface epithelial cells that is of uncertain functional significance, there is no convincing evidence that their chronic use causes structural or functional impairment of enteric nerves or intestinal smooth muscle. Nor are there reliable data to link chronic use of stimulant laxatives to colorectal cancer and other tumors. The risks of laxative abuse have been overemphasized, and this has minimized their rational use by physicians. Stimulant laxatives may be used chronically when patients fail to respond adequately to bulk or osmotic laxatives alone. These can be combined with bulk or osmotic laxatives in sufficient amounts to soften the stool, or they can be used alone, according to clinical circumstances. The dose of such agents should be titrated to effect. Bisacodyl may be used if anthraquinone laxatives are unsatisfactory.
University of Pittsburgh Medical Center, Pennsylvania 15213, USA. walda@msx.upmc.edu