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They’re the over-the-counter remedies relied upon by hundreds of thousands of Britons to ease digestive problems, but now new restrictions on laxatives mean many people may struggle with symptoms, and some could end up in hospital as a result.
That’s the warning from a world-leading expert on irritable bowel syndrome (IBS) following changes to the rules regarding the sale of laxatives.
Stimulant laxatives can rapidly ease the constipation experienced by an estimated 1.5 million IBS sufferers as their main symptom. This type of IBS is known as IBS-C.
The majority need to take laxatives on a ‘continuous, regular and indefinite basis’, says Peter Whorwell, a professor of medicine and gastroenterology at the University of Manchester.
Stimulant laxatives encourage muscles in the gut to contract and move stools through the body.
Popular products include Dulcolax and Senokot. Around 13.9 million packs were sold in the UK in 2016, one million of which were prescribed by GPs.
Now the drug safety watchdog, the Medicines and Healthcare products Regulatory Agency (MHRA), has set out new rules which ban retail outlets from selling stimulant laxatives to under-18s.
Retailers will also only be able to sell smaller packs of 20 standard tablets or ten maximum-strength, or 100ml syrup.
Pharmacists will have more flexibility to sell stimulant laxatives to under-18s and larger packs of up to 100 tablets.
The MHRA is also advising anyone with regular bouts of constipation against the long-term overuse of stimulant laxatives.
It says this can result in ‘damage to the digestive system, including chronic constipation and damage to the nerves and muscles of the colon’.
The regulations — issued last week — are designed to prevent laxatives from being abused by people with eating disorders.
But for many others, the new rules are a ‘disaster’, says Professor Whorwell, the author of 350 research papers on IBS. ‘I have written to the MHRA asking what their evidence is for saying long-term overuse of stimulants can damage the bowel,’ he adds.
‘This advice could endanger people with IBS. Many IBS-C patients need to use laxatives long-term. But this guidance may make them wrongly believe this is harmful, and they might stop using them.’
People with constipation are being advised to talk to a healthcare professional, who may recommend bulk-forming laxatives. These bulk up stools, making them easier to pass.
They are available over-the-counter, and some view them as safer because they are drug-free.
‘Bulk-forming laxatives can work well for people with a short-term problem, but they tend not to work so well in patients with IBS-C as they can cause bloating and gas,’ says Professor Whorwell.
He warns that if patients need a prescription for laxatives ‘their GP may not prescribe them’, adding: ‘A generation of doctors, including myself, have been wrongly taught that laxatives damage the bowel and should only be used on a short-term basis.’
‘I have no idea how this belief originated, as there is no evidence at all that they do any long-term harm at the therapeutic dose,’ he says.
‘We are constantly having to reassure GPs that the long-term use of laxatives is completely safe in patients with IBS-C.’
Another fear about laxatives is that they make your bowel sluggish and cause cancer — but there is no evidence for either, argues Professor Whorwell.
He worries some constipation patients could end up needing hospital treatment if they don’t have easy access to laxatives. In 2017/18, more than 71,000 people in England were admitted to hospital with constipation.
However, a review published in the Scandinavian Journal of Gastroenterology last year concluded the evidence ‘does not support the use of stimulant laxatives for more than four weeks’, and called for longer-term trials.
Eating disorder charity Beat has welcomed the restrictions, saying a 2014 survey of sufferers who abused laxatives found nearly all had bought them over-the-counter, and 66.7 percent had developed a dependency on them.
Professor Whorwell acknowledges this risk, but adds: ‘Perhaps we should be developing better ways of identifying and managing the serious problem of eating disorders, rather than coming up with a one-size-fits-all solution which could seriously affect the lives of another group of patients.’
Matt Birnholz, MDPeer