- Laxative Abuse
- Dangerous Eating Behaviours
- Magnesium citrate
- What is magnesium citrate?
- Important Information
- Before taking this medicine
- How should I take magnesium citrate?
- What happens if I miss a dose?
- What happens if I overdose?
- What should I avoid while taking magnesium citrate?
- Magnesium citrate side effects
- Magnesium citrate dosing information
- What other drugs will affect magnesium citrate?
- Further information
- More about magnesium citrate
- AGA Guideline: Treatment of opioid-induced constipation
- What Is Recommended for Chronic Constipation?
Laxatives are a type of medicine that can help you empty your bowels if you are having trouble going to the toilet.
They are widely used to treat constipation and are available over the counter (without a prescription or ‘OTC’) from pharmacies and supermarkets.
Things to consider
Just because laxatives are available over the counter does not mean they are safe and suitable for everyone.
Laxatives are not usually recommended for children unless advised by a doctor and some types of laxatives may not be safe to use if you have a bowel condition such as Crohn’s disease or ulcerative colitis.
You should always read carefully the patient information leaflet that comes with medication to make sure it is safe for you to take.
Read more about the considerations regarding laxatives.
Types of laxatives
The four most widely used laxatives are:
- osmotic laxatives which make your stools (‘poo’) softer by increasing the amount of water in your bowels
- stimulant laxatives which speed up the movement of your bowel by stimulating the muscles that line your digestive tract
- bulk-forming laxatives, also known as fibre supplements, work in the same way as dietary fibre; they increase the bulk of your stools by helping your stools retain fluid
- stool softener laxatives add water to your stools to lubricate them, making them more slippery and easier to pass
Less commonly used types of laxatives include:
- bowel cleansing solutions – these are often given to people who are going to have bowel surgery or a bowel examination to make sure that the bowel is empty and are not seen as a routine treatment for constipation
- peripheral opioid-receptor antagonists– these are used to treat constipation in people who are terminally ill where the constipation is the result of taking powerful painkiller medications such as morphine
- prucalopride – used to treat persistent constipation in women who have failed to respond to treatment (it is unclear whether prucalopride is safe or effective in men so its use in men is currently not recommended)
Laxatives are available as:
- tablets or capsules you swallow
- sachets of powder you mix with water and then drink
- suppositories – a capsule you place inside your rectum (back passage) where it will dissolve
Ideally, laxatives should only be used for short periods of time as prolonged use can make your body dependent on them, so your bowel no longer functions normally without them.
Recommendations can vary depending on the type of laxative but generally it is recommended that you do not take laxatives for more than 5-7 days in a row. If symptoms persist after this time contact your doctor for advice.
You should take a laxative with plenty of water as this can help prevent unpleasant side effects.
Read more information about the dosage of laxatives.
Common side effects of laxatives include:
- flatulence (breaking wind or ‘farting’)
- abdominal pain
These side effects are usually mild and should pass once you stop taking the laxatives.
The long-term use of laxatives can cause more troublesome side effects such as:
- unbalanced levels of salts and minerals in your body
Read more about the side effects of laxatives.
In many cases you can improve the symptoms of constipation without having to use laxatives through lifestyle changes, such as:
- increase your daily intake of fibre – you should eat at least 18-30g of fibre a day; high-fibre foods include fruit, vegetables and cereals
- add bulking agents, such as wheat bran, to your diet – these will help make your stools softer and easier to pass.
- drink plenty of water
- get more exercise by going for a daily walk or run
Read more about preventing constipation for more ways to change your diet and lifestyle.
Laxative abuse occurs when a person attempts to eliminate unwanted calories, lose weight, “feel thin,” or “feel empty” through the repeated, frequent use of laxatives. Often, laxatives are misused following eating binges, because the individual mistakenly believes that the laxatives will work to rush out food and calories before they can be absorbed — but that doesn’t really happen. Laxative abuse is serious and dangerous, often resulting in a variety of health complications and sometimes causing life-threatening conditions.
THE LAXATIVE MYTH
The belief that laxatives are effective for weight control is a myth. In fact, by the time laxatives act on the large intestine, most foods and calories have already been absorbed by the small intestine. Although laxatives artificially stimulate the large intestine to empty, the “weight loss” caused by a laxative-induced bowel movement contains little actual food, fat, or calories. Instead, laxative abuse causes the loss of water, minerals, electrolytes, and indigestible fiber and wastes from the colon. This “water weight” returns as soon as the individual drinks any fluids and the body re-hydrates. If the chronic laxative abuser refuses to re-hydrate, they risk dehydration, which further taxes the organs and which may ultimately cause death.
HEALTH CONSEQUENCES OF LAXATIVE ABUSE
- Disturbance of electrolyte and mineral balances. Sodium, potassium, magnesium, and phosphorus are electrolytes and minerals that are present in very specific amounts necessary for proper functioning of the nerves and muscles, including those of the colon and heart. Upsetting this delicate balance can cause improper functioning of these vital organs.
- Severe dehydration may cause tremors, weakness, blurry vision, fainting, kidney damage, and, in extreme cases, death. Dehydration often requires medical treatment.
- Laxative dependency occurs from overuse, and can cause the colon stops reacting to usual doses of laxatives so that larger and larger amounts of laxatives may be needed to produce bowel movements.
- Internal organ damage may result, including stretched or “lazy” colon, colon infection, irritable bowel syndrome, and, rarely, liver damage. Chronic laxative abuse may contribute to risk of colon cancer.
Learn more about health consequences >
Overcoming laxative abuse requires working with a team of health professionals who have expertise in treating eating disorders, including a general physician, a psychiatrist, psychologist, or counselor, and a registered dietician. Support from close friends and family is also helpful. Meeting with others to talk over anxieties, concerns, and difficulties can greatly aid in getting through tough times in the recovery process.
Find Treatment Options >
Learn More About Eating Disorders >
Dangerous Eating Behaviours
People with eating disorders use many different ways to try to lose weight or control their weight. For example, they may:
- Diet or take diet pills
- Purge by using laxatives and diuretics, or making themselves vomit
- Exercise too much or too often
- Cut out certain types of food
- Fast (go long periods of time without eating)
These are very unhealthy behaviours, and can be VERY dangerous. They can lead to serious medical problems, and even death. It is also important to note that some of these behaviours are not very effective in actually getting rid of calories.
This section has information about a few of these behaviours and how they affect a person’s health. It also has information about another dangerous behaviour associated with eating disorders – visiting pro-anorexia or pro-bulimia websites.
1. Dieting & Diet Pills
Dieting is a strong risk factor for developing an eating disorder. It is becoming more common, especially among young girls. We hear more and more about the dangers of being overweight or obese. We see images all around us that seem to say “to be beautiful and happy, you must also be thin.” All of this makes many of us feel like we need to lose weight. We know that happy and successful people come in many different shapes and sizes. But everywhere we look, we see ads encouraging us to lose weight, and tips on how to do it. People are more likely to diet when they are unhappy with their bodies, believe they are overweight, or have low self-esteem.
There is a big difference between dieting and eating healthy. Healthy eating is about taking care of your body, giving it the energy that it needs, as well as listening to our taste buds and being able to enjoy food. Dieting is about losing pounds and looking thin. People who diet are more likely to become obsessed with food. They may also be irritable and angry or depressed, and constantly feel tired. Dieters are at risk for a number of health problems. They often don’t eat enough different kinds of food and so they miss some of the nutrients they need. This is an especially big problem in children and teens because it can affect how they grow and develop. It can also weaken bones and lead to osteoporosis (weak or brittle bones). Girls who diet sometimes stop having their menstrual period.
Dieting often doesn’t help you to lose weight. In fact, research shows that people who are chronically trying to diet often end up overeating. Their overeating may be triggered by feeling sad or anxious, seeing or thinking about food, or believing that weight gain has occurred. There is now research that shows dieters may lose weight at first, but, in the long run, can actually gain weight. This is especially true among children and teens.
Many people with eating disorders also use diet pills. These pills are supposed to help weight loss or decrease appetite. They are considered dangerous because, in most cases, there is no proof that they work or are safe.
Purging means trying to get rid of food that was just eaten by forcing it out of the body quickly. Many people with eating disorders purge as a way to try to get rid of the calories they’ve just eaten. They are trying to prevent themselves from gaining weight. A person may purge by forcing themselves to throw up, or by using laxatives, diuretics, or other medications. They will usually do this in secret. Purging is extremely dangerous for a person’s health. It can cause many very serious medical complications. And it really isn’t effective at getting rid of calories. Purging is a sign of a very severe eating disorder. If you or someone you know is purging, you should get help from a healthcare professional immediately.
Some of the different ways of purging are:
- Self-Induced Vomiting: Many people with eating disorders make themselves vomit as a way to try to lose weight. They force themselves to throw up right after a meal. For some, vomiting is linked with bouts of over-eating or binge-eating. Most people induce vomiting by sticking their fingers down their throat. For this reason, they often develop a scar, or some hard skin, on the back of their hand. This is known as Russell’s sign. Self-induced vomiting can cause:
- damage to your esophagus, the tube that transports food from the mouth to the stomach
- damage to teeth that come in contact with stomach acid
- dehydration – loss of body fluids that have important minerals and electrolytes to help the heart and other organs to work properly
Some symptoms of repeated vomiting are muscle weakness, irregular heartbeat, and heart failure. Vomiting is also not effective in getting rid of all the calories consumed, as digestion begins in the mouth. In fact, vomiting tends to make binge-eating episodes more likely to happen.
- Ipecac Syrup: NOTE: You should ONLY use ipecac syrup in cases of accidental poisoning, and ONLY if it has been advised by a Poison Control Centre. In BC, the number for Poison Control is: 1.800.567.8911
Ipecac syrup makes you throw up soon after you drink it. It is used if someone eats or swallows something that is poisonous or toxic. For certain kinds of poisons, throwing up is useful. It may stop the poison from being absorbed into the stomach and causing damage to the body. Some people with eating disorders abuse ipecac by using it for the wrong reason. They drink it to make themselves throw up after eating. Ipecac syrup can be extremely harmful to your health and even lead to death.
Some symptoms of regular use of ipecac syrup include:muscle weakness, dehydration, heart problems, seizures, and internal bleeding.
The good news is the medical problems that come from ipecac abuse often disappear once the person stops drinking it. Like with other types of self-induced vomiting, using ipecac to make yourself throw up is not effective in getting rid of all the calories consumed, as digestion begins in the mouth. Inducing vomiting tends to make binge-eating episodes more likely to happen.
- Laxative Abuse: A laxative is a medication that is usually used to treat constipation. It acts on the large intestine to trigger a bowel movement. Laxative abuse is when you use laxatives to try to get rid of food you have just eaten. Some people take a laxative after eating a large amount of food (including after binge eating). People who abuse laxatives believe that they can empty out the food before their body can absorb the calories. They believe this will help them to lose weight, or control their weight. The truth is that laxatives do not stop your body from digesting food. They act on the large intestine, but most calories and fat are absorbed before they get to the large intestine. It is mostly water and minerals that are emptied from the body at this point. The “weight loss” is actually just a loss of water. This weight will return as soon as you drink something. If you continue to use laxatives and do NOT drink any fluids, you can become very dehydrated. People who are dehydrated feel weak and confused. It can do serious damage to the body, and to organs like the heart and kidneys. In extreme cases, you may have a heart attack or your kidneys may stop working properly. Many people need medical treatment to recover from dehydration.
Laxative abuse can do other damage to your health. It can result in the loss of important minerals and electrolytes like sodium, potassium or magnesium. As a result, your muscles, nerves and organs may not work properly. Laxative abuse can also damage your intestine, and increase your risk of getting colon cancer.
- Diuretic Abuse: Diuretics are sometimes called water pills because they help to get water out of your body. They are used to treat people who have medical conditions such as high blood pressure or edema (swelling in certain parts of the body). Diuretic abuse is when you misuse or use these pills improperly, in a way the doctor did not prescribe.
People with an eating disorder sometimes misuse diuretics in order to try to lose weight. They believe these pills will help them get rid of extra pounds. The truth is that they are just getting rid of water, and so any weight loss is temporary. The weight will return as soon as they drink anything. In the long run, diuretics can actually cause you to gain water weight. Your body will start holding on to water to offset the effects of the diuretic.
Diuretic abuse can cause a lot of medical problems. For example, it can cause very low blood pressure. This can make you feel weak and dizzy, or cause fainting. Also, the water that is lost when you use diuretics has important minerals and electrolytes. Your organs may not work properly. Some other side effects of diuretic abuse are kidney damage, dehydration, abnormal heart beat, dizziness and constipation.
3. Compulsive Exercising
Some people with an eating disorder use exercise as a way to control their weight. They may feel that they can only eat if they have finished their exercises. These people over-exercise, or do more physical activity than they need to stay healthy or fit. They may not feel happy or satisfied, but their exercise schedule becomes very important to them. They may begin to feel driven or compelled to exercise, and choose exercise over almost all other activities. If for some reason they can’t exercise, they feel guilty, anxious, depressed, irritable and upset.
You can damage your body with over-exercising, especially if that is combined with poor eating. The body is under a lot of stress because it is not getting the energy it needs to be so active. There is also no time for the body to rest, heal and recharge between workouts.
People with eating disorders who over-exercise may experience:
- weak bones
- bone fractures
- heart failure
- (for girls and women) loss of menstrual period
Female athletes who take part in sports such as dance, gymnastics, or marathons are at high risk of over-exercising. In fact, an eating disorder plus osteoporosis (brittle bones) and no menstrual period is known as the “Female Athlete Triad.”
Compulsive exercise is a sign of a serious eating disorder. If you, or someone you know, is exercising compulsively to lose weight, you should get help from a medical professional immediately.
4. Visiting Pro-Anorexia/Bulimia Websites
These internet sites encourage and promote eating disorders. They recommend some very dangerous behaviours. The sites are often called “Pro-Ana” (pro-anorexia) or “Pro-Mia” (pro-bulimia) pages. They talk as if anorexia nervosa or bulimia are lifestyle choices rather than disorders. The sites have chat rooms and blogs where people support each other in staying anorexic or bulimic and refusing treatment.
These websites often include:
- “Tips and Tricks” on how to lose weight
- “Thinspiration” – photos and quotes to motivate people to continue losing weight
- information about dieting and restricting calorie intake
- ways to lie and hide eating disorder symptoms
Just visiting one of these sites may decrease a person’s self-esteem and increase their body dissatisfaction. There has been research on teenagers with eating disorders who visit these sites. It shows they spend less time on schoolwork, and more time in hospital, compared to teenagers who were in treatment for an eating disorder who did not visit these sites.
It is important for families, friends and healthcare professionals to be aware of these sites. Visiting pro-eating disorder websites can prevent someone with an eating disorder from seeking the help and treatment they need.
- Digging up the Dirt on Dieting (VCH) ( English )
- Vomiting and Your Health ( English )
- Laxative Abuse ( English )
- Eating Disorders and Substance Use Graphic ( English )
Generic Name: magnesium citrate (mag NEE see um SIH trate)
Brand Name: Citrate of Magnesia, Citroma, Citroma Cherry, Citroma Lemon
Medically reviewed by Drugs.com on Sep 11, 2019 – Written by Cerner Multum
- Side Effects
What is magnesium citrate?
Magnesium is a naturally occurring mineral that is important for many systems in the body, especially the muscles and nerves. Magnesium citrate also increases water in the intestines.
Magnesium citrate is used as a laxative to treat occasional constipation.
Magnesium citrate may also be used for purposes not listed in this medication guide.
Follow all directions on your medicine label and package. Tell each of your healthcare providers about all your medical conditions, allergies, and all medicines you use.
Before taking this medicine
Ask a doctor or pharmacist if it is safe for you to take magnesium citrate if you have other medical conditions, especially:
a sudden change in bowel habits that has lasted longer than 2 weeks;
stomach pain, nausea, vomiting; or
if you are on a low-magnesium or low-potassium diet.
It is not known whether magnesium citrate will harm an unborn baby. Do not use this medicine without a doctor’s advice if you are pregnant.
It is not known whether magnesium citrate passes into breast milk or if it could harm a nursing baby. Do not use this medicine without a doctor’s advice if you are breast-feeding a baby.
How should I take magnesium citrate?
Use exactly as directed on the label, or as prescribed by your doctor. Do not use in larger or smaller amounts or for longer than recommended.
Take magnesium citrate on an empty stomach, at least 1 hour before or 2 hours after a meal.
Measure liquid medicine with the dosing syringe provided, or with a special dose-measuring spoon or medicine cup. If you do not have a dose-measuring device, ask your pharmacist for one.
Take this medicine with a full glass of water.
Magnesium citrate should produce a bowel movement within 30 minutes to 6 hours after you take the medicine.
Call your doctor if your symptoms do not improve after 7 days of treatment, or if the medicine produces no results. Not having a bowel movement after using a laxative may be a sign of a condition more serious than occasional constipation.
Store at room temperature away from moisture and heat.
What happens if I miss a dose?
Since magnesium citrate is used when needed, you may not be on a dosing schedule. If you are on a schedule, use the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not use extra medicine to make up the missed dose.
What happens if I overdose?
Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.
What should I avoid while taking magnesium citrate?
Avoid taking any other medicines within 2 hours before or 2 hours after you take magnesium citrate. Laxatives can make it harder for your body to absorb certain other drugs.
Magnesium citrate side effects
Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.
Stop using magnesium citrate and call your doctor at once if you have:
no bowel movement within 6 hours after taking the medicine;
pain with bowel movements, rectal bleeding;
watery diarrhea, nausea, vomiting, severe stomach pain;
painful or difficult urination;
flushing (warmth, redness, or tingly feeling);
a light-headed feeling, like you might pass out;
weak or shallow breathing, slow heartbeats; or
muscle weakness, increased thirst.
Common side effects may include:
loose stools, diarrhea, stomach cramps;
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
Magnesium citrate dosing information
Usual Adult Dose for Constipation:
240 mL orally one time.
Usual Pediatric Dose for Constipation:
6 to 12 years: 100 to 150 mL orally one time.
What other drugs will affect magnesium citrate?
Other drugs may interact with magnesium citrate, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell each of your health care providers about all medicines you use now and any medicine you start or stop using.
Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.
Copyright 1996-2018 Cerner Multum, Inc. Version: 2.02.
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Related treatment guides
AGA Guideline: Treatment of opioid-induced constipation
For patients with suspected opioid-induced constipation, start by taking a careful history of defecation and dietary patterns, stool consistency, incomplete evacuation, and “alarm symptoms,” such as bloody stools or weight loss, state new guidelines from the American Gastroenterological Association in Gastroenterology.
Clinicians also should rule out other causes of constipation, such as pelvic outlet dysfunction, mechanical obstruction, metabolic abnormalities, and comorbidities or concurrent medications, wrote Seth D. Crockett, MD, MPH, of the University of North Carolina at Chapel Hill, together with his associates. The guideline was published online Sept. 1.
Opioid therapy can lead to a range of gastrointestinal symptoms, such as constipation, gastroesophageal reflux, nausea and vomiting, bloating, and abdominal pain. Among these, constipation is by far the most common and debilitating, the guideline notes. In past studies, 40%-80% of patients who received opioids developed opioid-induced constipation (OIC), a more severe presentation that involves a combination of reduced stool frequency in addition to other symptoms, such as harder stools, new or worsening straining during defecation, and a sense of incomplete rectal evacuation.
Treating OIC should start with lifestyle interventions, such as drinking more fluids, toileting as soon as possible when feeling the urge to defecate, and adding regular moderate exercise whenever tolerable, the guideline advises. For patients on oral or parenteral therapy, consider switching to an equianalgesic dose of a less-constipating opioid, such as transdermal fentanyl or oxycodone-naloxone combination therapy.
Many patients with OIC require interventions beyond lifestyle changes or opioid switching. For these patients, the guideline advises starting with conventional laxative therapies based on their safety, low cost, and “established efficacy” in the OIC setting. Options include stool softeners (docusate sodium), osmotic laxatives (polyethylene glycol, magnesium hydroxide, magnesium citrate, and lactulose), lubricants (mineral oil), and stimulant laxatives (bisacodyl, sodium picosulfate, and senna). “Of note, there is little evidence that routine use of stimulant laxatives is harmful to the colon, despite widespread concern to the contrary,” the guideline states. Although randomized, controlled trials have not evaluated particular laxative combinations or titrations for OIC, the best evidence supports stimulant and osmotic laxative therapy, the authors note.
Before deeming any case of OIC laxative refractory, ensure that a patient receives an adequate trial of at least two classes of laxatives administered on a regular schedule, not just “as needed,” the guideline specifies. For example, a patient might receive a 2-week trial of a daily osmotic laxative plus a stimulant laxative two to three times weekly. The guideline authors suggest restricting the use of enemas to rescue therapy. They also note that consuming more fiber tends not to help patients with OIC because fiber does not affect colonic motility.
For truly laxative-refractory OIC, the guidelines recommend escalating treatment to peripherally acting mu-opioid receptor antagonists (PAMORAs). These drugs restore the function of the enteric nervous system by blocking mu-opioid receptors in the gut. Among the PAMORAs, the guideline strongly recommends the use of naldemedine or naloxegol over no treatment, based on robust data from randomized, double-blind, placebo-controlled trials. In the phase 3 COMPOSE 1, 2, and 3 trials, about 52% of patients who received naldemedine achieved at least three spontaneous bowel movements per week, compared with 35% of patients who received placebo. Additionally, in a 52-week safety and efficacy study (COMPOSE 3), naldemedine was associated with one more spontaneous bowel movement per week versus placebo and with a low absolute increase in adverse events.
The guideline bases its strong recommendation for naloxegol on moderate-quality data from three studies, including two phase 3, double-blind, randomized, placebo-controlled trials. Although at least five randomized, controlled trials have evaluated methylnaltrexone, the evidence was low quality and therefore the guideline only conditionally recommends prescribing this PAMORA over no treatment.
The guideline also makes no recommendation on the use of the intestinal secretagogue lubiprostone or the 5HT agonist prucalopride. Studies of lubiprostone were limited by possible reporting bias and showed no clear treatment benefit, the authors state. They describe a similar evidence gap for prucalopride, noting that at least one trial ended early without publication of the findings. They recommend further studying lubiprostone as well as prucalopride and other highly selective 5-HT4 agonists for treating OIC. Head-to-head trials would help guide treatment choice for patients with laxative-refractory OIC, they add. “Cost-effectiveness studies are also lacking in this field, which could inform prescribing strategy, particularly for newer, more expensive agents.”
What Is Recommended for Chronic Constipation?
I often see patients with complaints of “constipation.” What is most effective to offer them and how much investigation is warranted?
| Response from Bret A. Lashner, MD
Professor of Medicine, Cleveland Clinic, Cleveland, Ohio
Chronic constipation is a term that is defined by fewer than 3 bowel movements per week but patients often call “hard stools” constipation. Almost certainly, when a patient presents with complaints of constipation, the provider will instruct the patient to increase the amount of dietary fiber (fruits and vegetables) in his or her diet and add an osmotic laxative such as milk of magnesia. If symptoms are not relieved, then an evaluation may be in order.
First, a colonoscopy is necessary, especially if the patient is older than 50 years, to rule out a structural lesion as the cause of the change in bowel habits.
Next, a colonic transit study could provide valuable information. This study involves the ingestion of radio-opaque markers followed by an abdominal x-ray on day 7. If the markers are gone, then it should be possible to treat the constipation with fiber supplements and osmotic laxatives, such as MiraLAX®. If the markers are still present, then anorectal disorders, Hirschsprung disease, or colonic inertia must be considered.
To better evaluate the anal musculature, anorectal manometry is very helpful. Such testing can identify pelvic floor dysfunction, seen almost exclusively in women, as the cause of constipation. Some of these disorders may be treated with biofeedback techniques.
Osmotic laxatives such as milk of magnesia, magnesium citrate, and MiraLAX® all are available over the counter and safe to take for long periods of time. These laxatives simply add fluid to the bowel movement, which facilitates timely passage.
The stimulant laxatives, such as Dulcolax®, Ex-Lax®, Correctol®, and Senokot®, are not safe to take for long periods of time because the bowel becomes dependent on them.
Lubiprostone (Amitiza®) is approved for constipation-predominant irritable bowel syndrome (eg, constipation with abdominal pain). Lubiprostone is a type 2 chloride channel activator that stimulates fluid secretion into the bowel and accelerates transit time. Other approved medications include colchicine (used for treatment of gout) and misoprostol (a drug used to protect the lining of the stomach from aspirin and aspirin-like products).
Certainly, the very last resort for severe colonic inertia, when all else fails, is surgery to remove most of the colon. Such a drastic approach to chronic constipation is very rarely done.