Senna, magnesium oxide improves bowel movements in patients with constipation
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Senna and magnesium oxide both improved the frequency of bowel movements and may be effective for the treatment of constipation, according to study results.
“OTC agents are generally used next. Senna is a common stimulant laxative used in Asia to treat CIC, and [magnesium oxide] is also commonly used,” Daisuke Morishita, MD, from division of gastroenterology and hepatology, department of internal medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan, and colleagues wrote. “Anecdotal reports suggest that both can be used to treat symptoms of CIC, although neither has been studied in a prospective manner in an Asian population, and the two have never been compared directly.”
Morishita and colleagues identified 90 patients with chronic idiopathic constipation and randomly assigned them to 1 g of senna, a stimulant laxative, 1.5 g magnesium oxide or placebo for 28 consecutive days. Mean duration of symptoms was 9.9 years. Overall symptom improvement served as the primary endpoint. Other endpoints included spontaneous bowel movement, complete SBM and patient assessment of constipation quality of life.
The response rate for overall improvement in the placebo was 11.7% compared with 69.2% in the senna group and 68.3% in the magnesium oxide group (P < .0001). Change in SBM was greater in both the senna and magnesium oxide groups compared with the placebo group (P < .001). There were no severe treatment-related adverse events, according to reseachers.
“Similarly, change in complete SBM was significantly greater in the senna and [magnesium oxide] groups than that in the placebo group (P < .01),” investigators wrote.
Morshita and colleagues also reported improvements in patient assessment of constipation QoL in the senna and magnesium oxide groups vs. the placebo group (senna, P < .05; magnesium oxide, P < .001).
The authors report no relevant financial disclosures.
Perspective
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Adrienna Jirik, MD
CIC is a very common disorder, with a reported prevalence of about 11% -15% worldwide, with high female predominance. The optimal regimen for treating CIC is patient specific; there is no ‘one size fits all’ recipe. Intermittent use of stimulant laxatives like sennosides and osmotic laxatives like magnesium oxide is ok, but caution needs to be exercised with the use of magnesium-based products as these are renally excreted and can cause renal compromise, especially in patients with chronic kidney disease. The dosing used in this study was quite high (1 gram of sennoside and 1.5 gm of magnesium oxide) to reach their endpoint. Dosing guidelines in general typically do not exceed 68.8 mg daily dosing of sennosides, and although there are over-the-counter magnesium supplements available that recommend 1000-2000 mg daily, this would not be something I would recommend for daily/chronic use to my patients. My preference is to start with a soluble fiber supplement containing psyllium daily with adequate water consumption first, before adding an osmotic laxative (such as polyethylene glycol 3350). A stimulant laxative such as bisacodyl or senna can then be added to use on an as-needed basis if there is a sense of incomplete evacuation despite above.
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