There has been an increase in the usage of purgatives especially herbal ones recently. Purgatives also sometimes referred to as laxatives (more powerful laxatives) are substances that loosen stools, increase bowel movements within the intestines and eventual evacuation of bowel to relieve constipation. Several types of laxatives exist. These include; Bulk forming, stool-softeners (surfactants), osmotic agents (saline and hyperosmotic), lubricants (emollients) relistor (methylnaltrexone bromide) and natural stimulants.
Bulk forming laxatives work by absorbing fats and water into stool causing the stool to become bulky. The bulky stool generates force against the walls of the large intestines which in turn contracts to expel the stools. They are usually the first line of treatments for constipation. Examples are dietary fibres, psyllium husks (Metamucil), broccoli, methylcellulose (Citrucel), etc. Stool softeners are short-term constipation medications for people with heart conditions, piles (hemorrhoids), post-surgical patients, etc, who should avoid straining when the urge to release bowel is felt. They usually come in the form of capsules, syrups, tablets or liquids to be taken orally at bed time to soften stools overnight thus enabling smooth passage at day break. Examples are docusates, soflax, silace, etc. Osmotic laxatives work by increasing the amount of water secreted within the intestines. This produces softer stools for easy passage. Examples include lactulose, miralax (polyethylene glycol PEG), glycerin suppositories, milk of magnesia, Epsom salt, etc. Lubricant laxatives work in the colon for 6 to 8 hours, coats the stools to prevent absorption back into the body, making it slippery for fast and easy movements down the intestines. An example of such is mineral oil. Relistor (methylnaltrexone bromide) is a laxative for people with opoid-induced constipation (OIC). It reduces constipation caused by using opioids (narcotics) for a long time to treat severe chronic pain not caused by cancer (more than 4 weeks), without reducing the pain-relieving effects of the narcotic.
Natural Stimulant laxatives or purgatives are the most abused. Most manufactured herbal purgatives fall here. They are not supposed to be used as the initial therapy for constipation due to the nature of their work. Their use as first line treatment however is highly dose dependent and prescription based. Stimulant laxatives work by irritating the intestinal lining, increasing wavelike muscle contractions in the intestinal wall to effect the emptying of bowel. They are used to treat constipation unresponsive to the other laxative types, to empty intestines before exploratory surgical procedures on the bowel due to their very potent laxative effects and highly recommended for parasite removal. Examples are senna, cascara, bisacodyl (synthetic). Herbal practitioners (especially indigenous ones) believe diseases result from the accumulation of toxins and other harmful substances in the human body. Their understanding of the body is that phlegms (Amamai) and hemorrhoids/piles (kooko) presence at various parts of the body are responsible for most of the illnesses experienced by man. It is for this reason that natural stimulant plants are included in various herbal product formularies for different conditions to provide strong laxative/purgative effect alongside the therapeutic effects of other potent medicinal plants in the formulary. It is important to know that phlegms (Amamai), are thick liquids secreted by mucous membranes in the respiratory tract only. Mucous membranes however exist in the mouth, nasal passages, throat, stomach, eyelids, intestines, anus and vulva. These membranes secrete mucous that destroy bacteria and viruses, traps dirt, prevent water loss, humidifies passageways, lubricates movement of materials, and protect surfaces from damages. Mucous usually form part of the stool excreted from the large intestine as it helps excrete trapped waste materials from the body. The colour and amount of mucous in stools however may indicate an underlining medical condition usually of gastrointestinal system, just like an increase number of white blood cells in blood. Hemorrhoids/piles (kooko) only occurs in the rectum and not in places like the waist, conjunctiva of the eyes, stomach, uterus, head, etc, as claimed by some practitioners . Stimulant laxative plants included in formulations as mentioned earlier have the ability to eliminate parasites trapped by intestinal mucosa from the body through the bowel when the need arises.
Long time use, abuse or dependency on purgatives for bowel evacuation, “bowel cleansing”, and other purposes poses serious health complications to the body. Dehydration, electrolyte imbalances, increased infection risk, kidney damage, heart issues, laxative dependence, bleeding disorder, eating disorder, etc, are some of the harmful effects associated with purgatives abuse or long term use. Dehydration refers to the loss of excess water through urination or defecation. If a person uses a purgative or laxative meant to be used once to relieve constipation (with the accurate dosage) he or she would most likely not get dehydrated. Excessive use of purgatives causes diarrhea (watery stools) that leads to loss of large volumes of water needed for normal function of tissues and organs from through stools. In some people, the frequent bowel movements (diarrhea) induced by stimulant purgatives irritate the rectum and anus resulting in sores, bleeding or pain while using the toilet. Severe dehydration may cause tremors, weakness, blurry vision, fainting, and kidney damage. The kidneys are organs responsible for removal of large amount of body wastes generated from blood filtering. They need decent amount of water to go achieve process. With dehydration, there isn’t enough water available to the kidneys to flush generated body wastes out of the body through urine as they (right and left kidneys) should. This damages the kidneys overtime causing them to fail thereby contributing to toxin buildup in the body. This explains how severe dehydration from stimulant purgative abuse, without medical intervention may lead to death.
Electrolytes imbalance also results from the excessive loss of water (severe dehydration) through frequent diarrhea and kidney damage associated herbal purgative abuse. Electrolytes are chemical substances having many functions- from regulation of heartbeat to aiding muscle contraction to enable movement. Examples include; Potassium, Calcium, Magnesium, Sodium, Chloride, etc. Potassium help maintain a stable blood pressure levels, regulates heart contractions and muscle functions. Sodium and chloride help maintain fluid balance. Sodium is also required for nerve signaling and muscle contraction. Magnesium is required for proper heart rhythms, nerve function, bone-building, digestion, stable protein-fluid balance and anxiety reduction. Electrolytes are found within bodily fluids, blood, with their imbalance causing noticeable changes as a result of the several roles they play. Electrolyte imbalance presents with symptoms like insomnia (difficulty sleeping), bone disorders, heart palpitations/irregular heartbeats, confusion, joint pains, blood pressure changes, dizziness, anxiety, muscle problems (spasms, twitches, and weakness), fever, seizures, numbness, convulsions, lethargy, etc. Electrolyte imbalance aside severe dehydration from purgative use may also result from cancer treatments, congestive heart failure, prolonged vomiting, and acid/base (pH) imbalance.
Abuse or long term use of laxatives especially stimulant herbal purgatives increases the risk of infection. The intestine is coated with protective layer of mucus, which prevents the walls of the intestine from being irritated. Good bacteria that contribute positively to overall health and immune system function are present in the intestines. Purgative abuse wipes away these bacteria together with the protective mucus thus enhancing vulnerability to infections, irritations and bleeding (which causes bloody stools). Lastly purgative abuse causes purgative/laxative dependence. With this the colon or large intestines requires larger and larger doses of laxative/purgative to produce bowel movements. This makes people often become so dependent on purgatives/laxatives to the extent that their body loses the ability to produce bowel movements on its own without the intervention of laxatives.
BY: BENTIL EMMANUEL ASARE ADUSEI
BSC HERBAL MEDICINE, KNUST