Senna with ispaghula husk

How it works

Senna's anthraquinone components are activated by colonic bacteria to stimulate peristalsis and increase intestinal motility, while ispaghula husk absorbs water to increase faecal bulk and soften stool.

Prescribing in practice

• Bulk-forming agents such as ispaghula must be taken with plenty of fluid and must not be taken immediately before lying down, because inadequate fluid intake can cause oesophageal or intestinal obstruction.
• Both components are contraindicated in suspected intestinal obstruction, and stimulant laxatives should be avoided in that setting.
• Prolonged stimulant laxative use should be avoided and the cause of constipation addressed.

Monitoring

Review bowel response and the continued need for treatment, ensuring adequate fluid intake throughout.

Counselling the patient

• Take with a full glass of water and maintain a good fluid intake during the day.
• Do not take the bulk-forming dose just before going to bed.
• Stop and seek advice if you develop abdominal pain, bloating or no bowel movement.

Evidence & guidelines

The constituent laxatives have well-established efficacy and use is consistent with NICE constipation guidance.