Description and Brand NamesBefore UsingProper UsePrecautionsSide Effects Descriptions Rectal laxatives are used as enemas or suppositories to produce bowel movements in a short time. There are several different types of rectal laxatives and they work in different ways. Since directions for use are different for each type, it is important to know which one you are taking. The different types of rectal laxatives include: Carbon dioxide-releasing • Carbon dioxide-releasing laxatives (e.g., potassium bitartrate and sodium bicarbonate) are suppositories that encourage bowel movements by forming carbon dioxide, a gas. This gas pushes against the intestinal wall, causing contractions that move along the stool mass. Hyperosmotic • Hyperosmotic laxatives (e.g., glycerin; sodium phosphates) draw water into the bowel from surrounding body tissues. This provides a soft stool mass and increased bowel action. Lubricant • Mineral oil coats the bowel and the stool mass with a waterproof film. This keeps moisture in the stool. The stool remains soft and its passage is made easier. Stimulants • Stimulant laxatives (e.g., bisacodyl; senna), also known as contact laxatives, act on the intestinal wall. They increase the muscle contractions that move along the stool mass. Stool softeners (emollients) • Stool softeners (emollient laxatives—e.g., docusate) encourage bowel movements by helping liquids mix into the stool and prevent dry, hard stool masses. This type of laxative has been said not to cause a bowel movement but instead allows the patient to have a bowel movement without straining. Rectal laxatives may provide relief in a number of situations such as: • before giving birth. • for a few days after giving birth. • preparation for examination or surgery. • to aid in developing normal bowel function following a period of poor eating habits or a lack of physical exercise (glycerin suppositories only). • following surgery when straining should be avoided. • constipation caused by other medicines. Some of these laxatives are available only with your doctor’s prescription. Others are available without a prescription; however, your doctor may have special instructions for the proper use and dose for your medical condition. This product is available in the following dosage forms: • Enema • Suppository Allergies Tell your doctor if you have ever had any unusual or allergic reaction to medicines in this group or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully. Pediatric Laxatives should not be given to young children (up to 6 years of age) unless prescribed by their doctor. Since children cannot usually describe their symptoms very well, they should be checked by a doctor before being given a laxative. The child may have a condition that needs other treatment. If so, laxatives will not help and may even cause unwanted effects or make the condition worse. Also, weakness, increased sweating, and convulsions (seizures) may be especially likely to occur in children receiving enemas or rectal solutions, since they may be more sensitive than adults to their effects. Geriatric Weakness, increased sweating, and convulsions (seizures) may be especially likely to occur in elderly patients, since they may be more sensitive than younger adults to the effects of rectal laxatives. Drug Interactions Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. Tell your healthcare professional if you are taking any other prescription or nonprescription (over-the-counter [OTC]) medicine. Other Interactions Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco. Other Medical Problems The presence of other medical problems may affect the use of medicines in this class. Make sure you tell your doctor if you have any other medical problems, especially: • Appendicitis (or signs of) or • Rectal bleeding of unknown cause—These conditions need immediate attention by a doctor. Intestinal blockage—The use of laxatives may create other problems if this condition is present. For safe and effective use of laxatives: • Follow your doctor’s orders if this laxative was prescribed. • Follow the manufacturer’s package directions if you are treating yourself. For patients using the enema or rectal solution form of this medicine: • This medicine usually comes with patient directions. Read them carefully before using this medicine. • Lubricate anus with petroleum jelly before inserting the enema applicator. • Gently insert the rectal tip of the enema applicator to prevent damage to the rectal wall. • Results often may be obtained with: bisacodyl enema in 15 minutes to 1 hour. docusate enema in 2 to 15 minutes. glycerin enema in 15 minutes to 1 hour. mineral oil enema in 2 to 15 minutes. senna enema in 30 minutes, but may not occur for some individuals for up to 2 hours. sodium phosphates enema in 2 to 5 minutes. For patients using the suppository form of this medicine: • If the suppository is too soft to insert, chill the suppository in the refrigerator for 30 minutes or run cold water over it, before removing the foil wrapper. • To insert suppository: First remove the foil wrapper and moisten the suppository with cold water. Lie down on your side and use your finger to push the suppository well up into the rectum. • Results often may be obtained with: bisacodyl suppositories in 15 minutes to 1 hour. carbon dioxide–releasing suppositories in 5 to 30 minutes. glycerin suppositories in 15 minutes to 1 hour. senna suppositories in 30 minutes, but may not occur for some individuals for up to 2 hours. There are a large number of laxative products on the market. The dose of laxatives will be different for different products. The amount of enema or the number of suppositories that you use depends on the strength of the medicine. Follow your doctor’s orders if this medicine was prescribed, or follow the directions on the box if you are buying this medicine without a prescription. Storage Keep out of the reach of children. Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing. Do not keep outdated medicine or medicine no longer needed. Do not use any type of laxative: • if you have signs of appendicitis or inflamed bowel (such as stomach or lower abdominal pain, cramping, bloating, soreness, nausea, or vomiting). Instead, check with your doctor as soon as possible. • more often than your doctor prescribed. This is true even when you have had no results from the laxative • if you do not need it, as for the common cold, “to clean out your system,” or as a “tonic to make you feel better.” • if you miss a bowel movement for a day or two If you notice a sudden change in bowel habits or function that lasts longer than 2 weeks, or keeps returning off and on, check with your doctor before using a laxative. This will allow the cause of your problem to be determined before it becomes more serious. The “laxative habit”—Laxative products are overused by many people. Such a practice often leads to dependence on the laxative action to produce a bowel movement. In severe cases, overuse of some laxatives has caused damage to the nerves, muscles, and tissues of the intestines and bowel. If you have any questions about the use of laxatives, check with your health care professional. For patients using the enema or rectal solution form of this medicine: • Check with your doctor if you notice rectal bleeding, blistering, pain, burning, itching, or other sign of irritation not present before you started using this medicine For patients using the suppository form of this medicine: Do not lubricate the suppository with mineral oil or petroleum jelly before inserting into the rectum. To do so may affect the way the suppository works. Moisten only with water. Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention. Check with your doctor as soon as possible if any of the following side effects occur: Less common • Rectal bleeding, blistering, burning, itching, or pain (with enemas only) Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them: Less common • Skin irritation surrounding rectal area Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional. Call your doctor for medical advice about side effects.