Sterculia

How it works

Being an indigestible plant gum, it absorbs water in the gut to increase faecal mass, which stimulates peristalsis and softens the stool.

Prescribing in practice

• It must be taken with plenty of fluid and is contraindicated in intestinal obstruction, faecal impaction, and reduced gut motility because of the risk of bowel or oesophageal obstruction.
• It should not be taken immediately before going to bed, to reduce the risk of oesophageal blockage.
• Full effect may take a few days to develop, so dosing should not be escalated prematurely.

Monitoring

No laboratory monitoring is required; assess bowel-habit response and ensure adequate fluid intake.

Counselling the patient

• Take each dose with a full glass of water and maintain a good fluid intake through the day.
• Do not take it just before lying down or going to bed.

Evidence & guidelines

Bulk-forming laxatives such as sterculia are recommended by NICE as first-line treatment for constipation with inadequate dietary fibre.