Читать книгу Pathy's Principles and Practice of Geriatric Medicine - Группа авторов - Страница 519

Stimulant laxatives are widely used when osmotic laxatives have not had the desired effect. The adverse effects of stimulant laxatives in the treatment of constipation remain one of the most steadfast medical myths.⁸ Stimulant laxatives have been reported to damage the colon and cause laxative dependence. This perception may relate to the occurrence of melanosis coli, a dark‐brownish discoloration of the colon that occurs with long‐term use. The presence of melanosis coli has no functional significance. Prior studies reporting damage to the colonic enteric nerves and smooth muscle were anecdotal and uncontrolled. Many of these patients likely had pre‐existing abnormalities of the colon. When used at recommended doses, stimulant laxatives are unlikely to harm the colon.

Stimulant laxatives result in abdominal discomfort and electrolyte imbalance in some patients.⁵² The most commonly available stimulant laxatives include senna, bisacodyl, and sodium picosulfate. Compared with placebo, bisacodyl 10 mg daily for 3 days increased stool frequency, improved stool form, and reduced straining in adults with constipation.⁵³ A comparison of bisacodyl with sodium picosulfate (uncontrolled) showed improvement with both in about three‐quarters of subjects.⁵⁴