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Understanding Laxatives

Unless your doctor told you differently, you should take one or more laxatives daily if you’re taking opioids.


Laxatives fit into four main groups. Laxatives that 1) make things move, 2) add extra water, 3) soften the stool, or 4) come at the problem from a different angle.

  • Always follow the instructions on your prescription bottle.
    Never take a higher dose of your opioids, or take them more often than prescribed. Instructions on medicine bottles can be confusing. Short-acting opioids are often prescribed with a range of doses you can take. For example: “Take 1-2 tablets every 3 hours as needed for pain.” This means it’s OK to take up to 2 tablets within a 3-hour time window. You can also choose to take less than this, or not take it at all (if your pain is controlled). Take them with a sip of water, with or without food.
  • Take them when you have pain and need quick relief.
    These take about 30 minutes to start working and 1 ½ hour to get the most relief, so take them early on when you feel your pain creeping up.
  • If you don’t have pain, don’t take them.
    If your pain is manageable and you don’t expect it to get worse, you shouldn’t take this medicine. It should be used “as needed” when you have pain.
  • Take them before your pain gets severe.
    Try to “stay ahead” of your pain by taking your short-acting opioid early on when you notice your pain getting worse. If you wait until your pain is severe, it often takes more medication and a longer time to get your pain under control. Pay attention to your body as you learn about your pain and how you react to opioids. Most people start recognizing their body’s signals about when they need to take their short-acting opioid for breakthrough pain.
  • Choose the dose that matches your pain level.
    Most short-acting opioid prescriptions have a range of doses you can choose to take within a given time-period. A common example is take 1-2 tablets every 3 hours as needed. If your pain is severe, start with the higher dose (for example: 2 tablets). If your pain is less severe, you can start with the lower dose (for example: 1 tablet). If your pain isn’t significantly better after 30 minutes to an hour, you can take the rest of the dose.
  • Take them about 30 minutes before painful activities.
    Some people know they will have pain with certain activities, like walking or taking a long car ride. Think of activities that usually worsen your pain. To help you be more active, you may want to take your short-acting opioid 30 minutes beforehand.
  • If your short-acting opioid is not working well, talk to your care team.
    Every person is different and it can take some time to find the right medicines and right doses for you. Your care team might decide to increase the dose of your opioid or change to a different medication. The important thing is to let them know how you are doing.

Go to your Medicine Cabinet to learn more about your laxatives, how they work, and their side effects. Your Medicine Cabinet gives suggestions on how to adjust your laxative medications to stay regular.  The laxatives in your medicine cabinet are organized into “My Daily Constipation Plan” and “My Constipation Rescue Plan.”

My Daily Constipation Plan

Your Daily Constipation Plan includes laxative medications that should be taken daily to prevent and manage constipation. The daily constipation plan includes any laxatives your doctor has prescribed. It also includes Senna (Senakot) and polyethylene glycol (Miralax), two over-the-counter medicines that are safe to increase or decrease.

This plan also has step-by-step instructions for how to adjust your Senna (aka Senakot) and polyethylene glycol (Miralax) if you are still constipated. It also goes over what to do if you have diarrhea.

​

Tap to learn more about adjusting your laxatives to stay regular.

My Constipation Rescue Plan

Your Constipation Rescue Plan goes over what to do if you have severe constipation and your daily constipation plan is not working.

You should always call your care team if you need to use your rescue plan.

We recommend using the rescue plan if:

  • You have not had a bowel movement in 4 or more days, or

  • If you are still constipated despite taking maximum doses of Senna (Senakot) and polyethylene glycol (Miralax)

​

Tap to learn more about your Constipation Rescue Plan.

What are the differences between Senna and Miralax?

Senna (Senakot), 

8.6mg

Polyethylene glycol

(Miralax), 17g

Laxative

How it's taken

Tablets, taken once or twice a day

Powder mixed in liquid, taken once or twice a day

Sometimes works faster

Less likely to cause cramping

May cause cramping

Need to mix with 8 oz of fluid and drink, can cause bloating

Common starting dose

2 tablets in AM, and

2 tablets in PM

17 g, once per day

Maximum dose recommended

4 tablets in AM, and

4 tablets in PM

Max = 8 tablets per day

17 g in AM,

and

17 g in PM

Max = 34 g 

per day

Common Questions when Using Laxatives

  • Always follow the instructions on your prescription bottle.
    Never take a higher dose of your opioids, or take them more often than prescribed. Instructions on medicine bottles can be confusing. Short-acting opioids are often prescribed with a range of doses you can take. For example: “Take 1-2 tablets every 3 hours as needed for pain.” This means it’s OK to take up to 2 tablets within a 3-hour time window. You can also choose to take less than this, or not take it at all (if your pain is controlled). Take them with a sip of water, with or without food.
  • Take them when you have pain and need quick relief.
    These take about 30 minutes to start working and 1 ½ hour to get the most relief, so take them early on when you feel your pain creeping up.
  • If you don’t have pain, don’t take them.
    If your pain is manageable and you don’t expect it to get worse, you shouldn’t take this medicine. It should be used “as needed” when you have pain.
  • Take them before your pain gets severe.
    Try to “stay ahead” of your pain by taking your short-acting opioid early on when you notice your pain getting worse. If you wait until your pain is severe, it often takes more medication and a longer time to get your pain under control. Pay attention to your body as you learn about your pain and how you react to opioids. Most people start recognizing their body’s signals about when they need to take their short-acting opioid for breakthrough pain.
  • Choose the dose that matches your pain level.
    Most short-acting opioid prescriptions have a range of doses you can choose to take within a given time-period. A common example is take 1-2 tablets every 3 hours as needed. If your pain is severe, start with the higher dose (for example: 2 tablets). If your pain is less severe, you can start with the lower dose (for example: 1 tablet). If your pain isn’t significantly better after 30 minutes to an hour, you can take the rest of the dose.
  • Take them about 30 minutes before painful activities.
    Some people know they will have pain with certain activities, like walking or taking a long car ride. Think of activities that usually worsen your pain. To help you be more active, you may want to take your short-acting opioid 30 minutes beforehand.
  • If your short-acting opioid is not working well, talk to your care team.
    Every person is different and it can take some time to find the right medicines and right doses for you. Your care team might decide to increase the dose of your opioid or change to a different medication. The important thing is to let them know how you are doing.

Common over-the-counter laxatives

  • Always follow the instructions on your prescription bottle.
    Never take a higher dose of your opioids, or take them more often than prescribed. Instructions on medicine bottles can be confusing. Short-acting opioids are often prescribed with a range of doses you can take. For example: “Take 1-2 tablets every 3 hours as needed for pain.” This means it’s OK to take up to 2 tablets within a 3-hour time window. You can also choose to take less than this, or not take it at all (if your pain is controlled). Take them with a sip of water, with or without food.
  • Take them when you have pain and need quick relief.
    These take about 30 minutes to start working and 1 ½ hour to get the most relief, so take them early on when you feel your pain creeping up.
  • If you don’t have pain, don’t take them.
    If your pain is manageable and you don’t expect it to get worse, you shouldn’t take this medicine. It should be used “as needed” when you have pain.
  • Take them before your pain gets severe.
    Try to “stay ahead” of your pain by taking your short-acting opioid early on when you notice your pain getting worse. If you wait until your pain is severe, it often takes more medication and a longer time to get your pain under control. Pay attention to your body as you learn about your pain and how you react to opioids. Most people start recognizing their body’s signals about when they need to take their short-acting opioid for breakthrough pain.
  • Choose the dose that matches your pain level.
    Most short-acting opioid prescriptions have a range of doses you can choose to take within a given time-period. A common example is take 1-2 tablets every 3 hours as needed. If your pain is severe, start with the higher dose (for example: 2 tablets). If your pain is less severe, you can start with the lower dose (for example: 1 tablet). If your pain isn’t significantly better after 30 minutes to an hour, you can take the rest of the dose.
  • Take them about 30 minutes before painful activities.
    Some people know they will have pain with certain activities, like walking or taking a long car ride. Think of activities that usually worsen your pain. To help you be more active, you may want to take your short-acting opioid 30 minutes beforehand.
  • If your short-acting opioid is not working well, talk to your care team.
    Every person is different and it can take some time to find the right medicines and right doses for you. Your care team might decide to increase the dose of your opioid or change to a different medication. The important thing is to let them know how you are doing.
Suppositories
  • Always follow the instructions on your prescription bottle.
    Never take a higher dose of your opioids, or take them more often than prescribed. Instructions on medicine bottles can be confusing. Short-acting opioids are often prescribed with a range of doses you can take. For example: “Take 1-2 tablets every 3 hours as needed for pain.” This means it’s OK to take up to 2 tablets within a 3-hour time window. You can also choose to take less than this, or not take it at all (if your pain is controlled). Take them with a sip of water, with or without food.
  • Take them when you have pain and need quick relief.
    These take about 30 minutes to start working and 1 ½ hour to get the most relief, so take them early on when you feel your pain creeping up.
  • If you don’t have pain, don’t take them.
    If your pain is manageable and you don’t expect it to get worse, you shouldn’t take this medicine. It should be used “as needed” when you have pain.
  • Take them before your pain gets severe.
    Try to “stay ahead” of your pain by taking your short-acting opioid early on when you notice your pain getting worse. If you wait until your pain is severe, it often takes more medication and a longer time to get your pain under control. Pay attention to your body as you learn about your pain and how you react to opioids. Most people start recognizing their body’s signals about when they need to take their short-acting opioid for breakthrough pain.
  • Choose the dose that matches your pain level.
    Most short-acting opioid prescriptions have a range of doses you can choose to take within a given time-period. A common example is take 1-2 tablets every 3 hours as needed. If your pain is severe, start with the higher dose (for example: 2 tablets). If your pain is less severe, you can start with the lower dose (for example: 1 tablet). If your pain isn’t significantly better after 30 minutes to an hour, you can take the rest of the dose.
  • Take them about 30 minutes before painful activities.
    Some people know they will have pain with certain activities, like walking or taking a long car ride. Think of activities that usually worsen your pain. To help you be more active, you may want to take your short-acting opioid 30 minutes beforehand.
  • If your short-acting opioid is not working well, talk to your care team.
    Every person is different and it can take some time to find the right medicines and right doses for you. Your care team might decide to increase the dose of your opioid or change to a different medication. The important thing is to let them know how you are doing.
Enemas
  • Always follow the instructions on your prescription bottle.
    Never take a higher dose of your opioids, or take them more often than prescribed. Instructions on medicine bottles can be confusing. Short-acting opioids are often prescribed with a range of doses you can take. For example: “Take 1-2 tablets every 3 hours as needed for pain.” This means it’s OK to take up to 2 tablets within a 3-hour time window. You can also choose to take less than this, or not take it at all (if your pain is controlled). Take them with a sip of water, with or without food.
  • Take them when you have pain and need quick relief.
    These take about 30 minutes to start working and 1 ½ hour to get the most relief, so take them early on when you feel your pain creeping up.
  • If you don’t have pain, don’t take them.
    If your pain is manageable and you don’t expect it to get worse, you shouldn’t take this medicine. It should be used “as needed” when you have pain.
  • Take them before your pain gets severe.
    Try to “stay ahead” of your pain by taking your short-acting opioid early on when you notice your pain getting worse. If you wait until your pain is severe, it often takes more medication and a longer time to get your pain under control. Pay attention to your body as you learn about your pain and how you react to opioids. Most people start recognizing their body’s signals about when they need to take their short-acting opioid for breakthrough pain.
  • Choose the dose that matches your pain level.
    Most short-acting opioid prescriptions have a range of doses you can choose to take within a given time-period. A common example is take 1-2 tablets every 3 hours as needed. If your pain is severe, start with the higher dose (for example: 2 tablets). If your pain is less severe, you can start with the lower dose (for example: 1 tablet). If your pain isn’t significantly better after 30 minutes to an hour, you can take the rest of the dose.
  • Take them about 30 minutes before painful activities.
    Some people know they will have pain with certain activities, like walking or taking a long car ride. Think of activities that usually worsen your pain. To help you be more active, you may want to take your short-acting opioid 30 minutes beforehand.
  • If your short-acting opioid is not working well, talk to your care team.
    Every person is different and it can take some time to find the right medicines and right doses for you. Your care team might decide to increase the dose of your opioid or change to a different medication. The important thing is to let them know how you are doing.

ALWAYS ask your care team if enemas and suppositories are safe for you before using them.

Common prescription laxatives

  • Always follow the instructions on your prescription bottle.
    Never take a higher dose of your opioids, or take them more often than prescribed. Instructions on medicine bottles can be confusing. Short-acting opioids are often prescribed with a range of doses you can take. For example: “Take 1-2 tablets every 3 hours as needed for pain.” This means it’s OK to take up to 2 tablets within a 3-hour time window. You can also choose to take less than this, or not take it at all (if your pain is controlled). Take them with a sip of water, with or without food.
  • Take them when you have pain and need quick relief.
    These take about 30 minutes to start working and 1 ½ hour to get the most relief, so take them early on when you feel your pain creeping up.
  • If you don’t have pain, don’t take them.
    If your pain is manageable and you don’t expect it to get worse, you shouldn’t take this medicine. It should be used “as needed” when you have pain.
  • Take them before your pain gets severe.
    Try to “stay ahead” of your pain by taking your short-acting opioid early on when you notice your pain getting worse. If you wait until your pain is severe, it often takes more medication and a longer time to get your pain under control. Pay attention to your body as you learn about your pain and how you react to opioids. Most people start recognizing their body’s signals about when they need to take their short-acting opioid for breakthrough pain.
  • Choose the dose that matches your pain level.
    Most short-acting opioid prescriptions have a range of doses you can choose to take within a given time-period. A common example is take 1-2 tablets every 3 hours as needed. If your pain is severe, start with the higher dose (for example: 2 tablets). If your pain is less severe, you can start with the lower dose (for example: 1 tablet). If your pain isn’t significantly better after 30 minutes to an hour, you can take the rest of the dose.
  • Take them about 30 minutes before painful activities.
    Some people know they will have pain with certain activities, like walking or taking a long car ride. Think of activities that usually worsen your pain. To help you be more active, you may want to take your short-acting opioid 30 minutes beforehand.
  • If your short-acting opioid is not working well, talk to your care team.
    Every person is different and it can take some time to find the right medicines and right doses for you. Your care team might decide to increase the dose of your opioid or change to a different medication. The important thing is to let them know how you are doing.
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