Laxative (Rectal)

Rectal laxatives are medications that are taken via the rectum to produce a bowel movement within a short period of time.

Overview

This type of laxatives generally falls into two main categories which are enemas and suppositories and are supplied in various dosage forms.

Types of enemas and suppositories laxatives include lubricant, carbon-dioxide releasing, stimulants, hyperosmotic, and stool softeners (emollients).

They usually work in different ways, but each of them has certain ingredients to cause a bowel movement.

Generally, laxatives stimulate the muscles in the intestines in such a way that they contract and move stool out of the body. In some cases, a laxative may work to soften the stool. This makes it easier for the patient to move the bowel.

Brand names for laxatives sold in the US are Fleet Bisacodyl, Enemeez Plus Mini Enema, Dulcolax, Colace, Fleet Babylax, Sani-Supp, The Magic Bullet, Fleet Glycerin, Dulcolax Bowel Cleansing Kit, Enemeez Mini Enema, and Fleet Mineral Oil.

Some of these laxatives are available with or without a prescription. Patients are required to follow special directions for using them even if they buy them over-the-counter.

Conditions Treated

Types of medicine

  • Enema
  • Suppository

Side Effects

Laxatives may cause certain expected side effects. Unwanted side effects may also occur and may or may not need medical attention.

Speak with your doctor as soon as possible if you develop the following side effects while using any of these laxatives:

Less commonly occuring:

  • Burning, blistering, itching or pain (after using enemas)
  • Bleeding of the rectum

Some side effects occur that may not require medical care. They can be managed by the patient and may eventually go away on their own.

The following side effects may not need medical attention. If it occurs but gets worse, bothersome or does not go away, tell your doctor.

Less commonly occur

  • Irritation of the skin around the rectal area

Extremely rare (but serious) side effect

Although extremely rare, an enema may cause an embolism (or blockage) to form if excess liquid or solution is released into the rectum. Embolisms that occur in the lungs may cause death.

Some patients may experience other side effects not listed here. You should talk with your doctor or healthcare professional if you notice other side effects that bother you or do not go away.

Check with your doctor or healthcare professional if you have questions about the use of laxatives. You can also ask them about ways to reduce or prevent side effects.

You may report side effects to the FDA by calling 1-800-FDA-1088.

Dosage

If this medicine was prescribed, your doctor will tell you your dosage. Dosage information will also be on the prescription label of the product packet.

The number of suppositories or the amount of enema solution you should use will depend on the strength of the medicine.

Enema or rectal solution treatment at home

An enema treatment is a liquid solution containing a stool softener. It is used to stimulate the intestinal muscles and push stool out of the rectum. It is typically used as a last resort for treating severe constipation.

If you are taking the enema treatment at home, the following may help you to prepare and use your medicine safely and effectively.

You should carefully read the patient information leaflet that comes with the medicine in addition to the directions on the prescription label.

Your doctor or pharmacist may also give you special instructions for using the enema. Stick to the instructions given to you, as the following is only a general guide:

  • Cleanse your hands thoroughly by washing with soap and water, then dry them.
  • Use a small amount of petroleum jelly to lubricate the anus. This will make it easier to insert the enema applicator.
  • Gently, insert the tip of the enema applicator to prevent irritation or injury to the tissues in the rectum. Continue to follow the instructions of your enema treatment to release the enema solution into your rectum.
  • You should now wait for a bowel movement.

After all the solution is emptied into the colon via the rectum, you should have a bowel movement within a certain time. Timeframes are based on the type of enema treatment used.

Call your doctor if you do not have a bowel movement within the approximate time.

Results timeframe for the following enema treatments are as follow:

  • Glycerin enema: 15 minutes to one hour
  • Mineral oil enema: Two to 15 minutes
  • Bisacodyl enema: 15 minutes to one hour
  • Sodium phosphates enema: Two to five minutes
  • Docusate enema: Two to 15 minutes
  • Senna enema: 30 minutes (may take up to two hours for some people)

Suppository treatment at home

To insert suppository:

Sometimes the suppository gets soft and will not insert as it should. If this is the case, place it into the refrigerator and let it stand for about 30 minutes. This will harden it.

Another option is to run/pour cold water over it before you remove it from the wrapper. Once the suppository is moist and ready to insert, do the following:

  • Wash your hands thoroughly with soap and water, then dry them.
  • You may lubricate the tip of the suppository as directed.
  • Lie on your side with your legs straightened. Pull your upper leg upwards, with bended knee pointing outwards.
  • Lift the upper buttock to expose the rectum.
  • Using the pointed end of the suppository, slowly and gently insert the suppository with your finger.

It is important to slide the suppository in far enough (about 1-inch inwards for adults) to prevent it from slipping out of the rectum.

  • Remain in your lying position for about 5 minutes to allow the medicine to dissolve and release into the rectum.
  • Throw away materials used and wash your hands thoroughly.

Results timeframe for suppository treatments are as follow:

  • Bisacodyl suppositories: 15 minutes to 1 hour.
  • Senna suppositories: 30 minutes (may take up to 2 hours for some people)
  • Glycerin suppositories: 15 minutes to 1 hour
  • Carbon dioxide'releasing suppositories: 5 to 30 minutes

Missed dose

Not applicable

Overdose

Not applicable

Interactions

Food, alcohol, and tobacco

If your laxative is bought over the counter, the patient information leaflet may caution you on the use of certain foods, alcohol or tobacco. For prescription laxatives, your doctor or pharmacist may give you special instructions on these.

Other medicines

It may not be safe to use other types of laxatives, blood thinners, castor oil, antibiotics, mineral oil, or medications for bone or heart condition with rectal stimulant laxatives.

Some laxatives may prevent or reduce the absorption of nutrients or medicines by your body.

Other medical problems

The presence of other medical problems may affect or be affected by the use of any of the laxatives discussed in this guide. Tell your doctor about any medical problem you may have, especially the following:

If you have the following condition, using laxatives may cause other problems.

  • Blockage of the intestines

Seek immediate medical attention if you have the following:

  • Rectal bleeding due to an unknown cause

Warnings

  • Do not use any of these laxatives if you are allergic to them or any of their ingredients.
  • Tell your doctor if you are allergic to certain foods, dyes, preservatives, or animals.
  • Do not use laxatives in children under the age of 6 years, unless their doctor prescribed it. Their doctor may also prefer an alternative treatment to laxative to prevent certain side effects or making their condition worse.
  • If you are pregnant, may be pregnant or breastfeeding there may be potential risks to an unborn baby or breastfeeding infant. You should ask your doctor if these types of laxatives are safe for you.
  • You should know that side effects, such as increased sweating, convulsions (seizures) or weakness, may especially occur in children taking enemas or rectal solution laxatives. This is because they are more sensitive to side effects.
  • Elderly patients taking enemas or rectal solution laxatives may also be more sensitive to side effects than younger adults. They may experience convulsions (seizures), weakness or increased sweating.
  • Do not use any type of laxative if you have appendicitis.
  • Do not use laxatives if you have symptoms of inflamed bowels such as cramping, pain in the stomach or lower abdomen, soreness, nausea or vomiting.
  • Laxatives should not be used to cause a bowel movement if you missed your stool for only 1 or 2 days.
  • Do not use laxatives more often than you should, even if it did not produce a bowel movement as expected. Laxative overuse may cause damage to the tissues, muscles, or nerves of the bowel and intestines.
  • Tell your doctor if there are changes in your bowel function or habits that last more than 2 weeks. Do this before using any laxatives. Your doctor may check you for underlying causes of these changes before deciding to treat you with laxatives.
  • If you are using enemas or rectal solution laxatives, tell your doctor if you experience bleeding of the rectum, burning, blistering, itching, pain or irritation that started after you used the medicine.
  • If you are using the rectal suppository laxative, do not lubricate the suppository with petroleum jelly or mineral oil before inserting it into the rectum. This may affect the way the medicine works.
  • Instead, follow the directions for lubrication and insertion stated on the patient information leaflet or prescription label.
  • Call your doctor right away if you see blood in your stool after you take an enema. This may be a sign of rectal damage or a medical problem.
  • Use enemas once a day, unless otherwise directed by your doctor. The risk of complications from enemas is higher if you insert the tube several times a day.
  • Use enemas around the same time each day to help the body produce a regular bowel movement. If you do not get a bowel movement after a few days, check with your doctor.
  • You should use enemas with great care to avoid causing a hole in the rectum.
  • Use over-the-counter enemas with caution. Studies show that some of them may cause kidney failure or complications due to the sodium phosphate they contain.

Storage

Keep the medicine away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Throw away medicine that is expired or no longer needed.

Summary

The use of rectal laxatives, such as enemas or suppositories, may be a safe and effective way to soften stool or stimulate the intestines to produce a bowel movement.

While this is the case, certain people should not use these laxatives. They include children under the age of 6 who may be treated with such laxatives only if their doctor prescribes one.

While rectal suppositories may be safer to use, enemas may provide greater results especially in severe cases of constipation or lack of bowel movement.

However, there may be a higher risk of damage to the tissues, muscles, or nerves of the intestines, bowels or rectum if enemas are not administered safely. Other complications such as rectal bleeding may also occur from the use of enemas.

Patients should ensure they use a laxative that is most suitable for them based on the level of need for a bowel movement and their present health condition.

Speaking with their doctor before taking these types of rectal laxatives may reduce the chance of side effects and related complications.

Patients are required to carefully follow all directions given, whether their laxative is by prescription or over-the-counter. This helps prevent rectal injury and reduce interactions with other medicines or medical conditions present in patients.