Senna
Place In Therapy
Senna is a stimulant laxative
that increases the gut motility and ultimately decreases fluid absorption. It
is a widely-used laxative for the management of chronic constipation. Despite
its popularity, there are not any large, good-quality studies to determine
its efficacy in chronic constipation.
The first steps when managing chronic constipation are lifestyle modifications and dietary changes, including fibre supplementation and/or bulk-forming agents. Lifestyle modifications can include attempting to have a bowel movement at the same time each day, increase daily caloric intake in the presence of low-calorie diets, increase physical activity, and drink juices that contain sorbitol (ex. apple or pear) or prune juice. If ineffective, osmotic or saline laxative can be added as second line. If all these have failed to provide adequate relief, this is where stimulants, such as senna, or emollients can be added. There is a lack of data demonstrating the effectiveness of senna, and whatever evidence that is available is from small, old, poorly-designed trials. Senna is only to be used for short-term relief and then discontinued once relief is achieved to help prevent long-term safety implications. Although no studies have confirmed any harm with long-term use, there is a theoretical concern of damaging the enteric nervous system and the smooth muscles of the colon.
References
The first steps when managing chronic constipation are lifestyle modifications and dietary changes, including fibre supplementation and/or bulk-forming agents. Lifestyle modifications can include attempting to have a bowel movement at the same time each day, increase daily caloric intake in the presence of low-calorie diets, increase physical activity, and drink juices that contain sorbitol (ex. apple or pear) or prune juice. If ineffective, osmotic or saline laxative can be added as second line. If all these have failed to provide adequate relief, this is where stimulants, such as senna, or emollients can be added. There is a lack of data demonstrating the effectiveness of senna, and whatever evidence that is available is from small, old, poorly-designed trials. Senna is only to be used for short-term relief and then discontinued once relief is achieved to help prevent long-term safety implications. Although no studies have confirmed any harm with long-term use, there is a theoretical concern of damaging the enteric nervous system and the smooth muscles of the colon.
References
- Ang A, Bouchard P, Champagne MC et al. Constipation. The Practical Guide to Nonprescription Drugs. 2nd Edition. 90-97. 2008.
- Bowels-Jordan J. Constipation. Patient Self Care. First Edition. 21: 222-36. 2002.
- Connolly P, Hughes IW and Ryan G. Comparison of ‘Duphalac’ and ‘irritant’ laxatives during and after treatment of chronic constipation: a preliminary study. Curr. med. Res. Opin (1975). 2,620.
- Liu LWC. Chronic constipation: Current treatment options. Can J Gastroenterol (2011). 25:22B-28B.
- Pare P et al. Recommendation on chronic constipation (including constipation associated with irritable bowel syndrome) treatment. Can J Gastroenterol (2007). Suppl B:3B-22B.
- Passmore AP, Wilson-Davies K, Stroker C and Scott ME. Chronic constipation in long stay elderly patients: a comparison of lactulose and a senna-fibre combination. BMJ (1993). 307(6907):769-71.
- Senna. Lexi-Drugs. LexiComp. Accessed online March 2, 2012.