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Senna contains hydroxyanthracene glycosides known as sennosides. These glycosides stimulate colon activity and thus have a laxative effect. Also, these glycosides increase fluid secretion by the colon, with the effect of softening the stool and increasing its bulk.1 Double-blind trials have confirmed the benefit of senna in treating constipation.1, 2Constipation induced by drugs such as the anti-diarrhea medicine loperamide (Imodium) has also been shown to be improved by senna in a clinical trial.3
The laxatives most frequently used world-wide come from plants. Herbal laxatives are either bulk-forming or stimulating.
Bulk-forming laxatives come from plants with a high fiber and mucilage content that expand when they come in contact with water; examples include psyllium, flaxseed, and fenugreek. As the volume in the bowel increases, a reflex muscular contraction occurs, stimulating a bowel movement. These mild laxatives are best suited for long-term use in people with constipation.
Many doctors recommend taking 7.5 grams of psyllium seeds or 5 grams of psyllium husks, mixed with water or juice, one to two times per day. Some doctors use a combination of senna (18%) and psyllium (82%) for the treatment of chronic constipation. This has been shown to work effectively for people in nursing homes with chronic constipation.4
Stimulant laxatives are high in anthraquinone glycosides, which stimulate bowel muscle contraction. The most frequently used stimulant laxatives are senna leaves, cascara bark, and aloe latex. While senna is the most popular, cascara has a somewhat milder action. Aloe is very potent and should be used with caution. Other stimulant laxatives include buckthorn, alder buckthorn (Rhamnus frangula), and rhubarb (Rheum officinale, R. palmatum).
1. Passmore AP, Davies KW, Flanagan PG, et al. A comparison of Agiolax and Lactulose in elderly patients with chronic constipation. Pharmacol 1993;47(suppl 1):249-52.
2. Kinnunen O, Winblad I, Koistinen P, Salokannel J. Safety and efficacy of a bulk laxative containing senna versus lactulose in the treatment of chronic constipation in geriatric patients. Pharmacol 1993;47(suppl 1):253-5.
3. Ewe K, Ueberschaer B, Press AG. Influence of senna, fibre, and fibre+senna on colonic transit in loperamide-induced constipation. Pharmacol 1993;47(suppl 1):242-8.
4. Passmore AP, Wilson-Davies K, Flanagan PG, et al. Chronic constipation in long stay elderly patients: a comparison of lactulose and senna-fiber combination. BMJ 1993; 307:769-71.
The senna shrub grows in India, Pakistan, and China. The leaves and pods are used medicinally.
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The information presented by Healthnotes is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires December 2018.
Do not use when nausea or vomiting are present unless directed by a doctor. Consult a doctor if you notice a sudden change in bowel habits that persists over 2 weeks. Rectal bleeding or failure to move bowels after use may indicate a serious condition. Discontinue use and consult a doctor. Read and follow directions carefully. Do not use if you have or develop diarrhea, loose stools or abdominal pain because senna may worsen these conditions and be harmful to your health. Consult your physician if you have frequent diarrhea or if you are pregnant, nursing, taking medication or have a medical condition.