Sterculia with frangula

How it works

Sterculia is a non-absorbable hydrophilic fibre that swells with water to increase faecal mass and stimulate peristalsis, while frangula provides anthraquinone stimulant activity that increases colonic motility and secretion.

Prescribing in practice

• Take with plenty of fluid and never immediately before lying down or going to bed, as bulk-forming agents can cause oesophageal or intestinal obstruction if swallowed dry, especially in patients with swallowing difficulty.
• Avoid in suspected or established intestinal obstruction, faecal impaction or colonic atony, where bulk-forming and stimulant action is inappropriate.
• The stimulant frangula component is generally not recommended for prolonged uninterrupted use as it may contribute to dependence and electrolyte disturbance.

Monitoring

Review response and bowel habit periodically, and reassess if there is no improvement or if abdominal pain or rectal bleeding develops.

Counselling the patient

• Maintain a good fluid intake throughout the day for the bulking agent to work safely.
• It may take a day or two to have full effect.
• Seek advice if you have severe abdominal pain, vomiting or no bowel movement.

Evidence & guidelines

Bulk-forming and stimulant laxatives are well-established options within the standard stepwise approach to constipation supported by UK guidance.