The FDA has issued a safety announcement regarding the use of over-the-counter (non-prescription) laxatives containing sodium phosphate. According to the FDA, exceeding one dose of this type of laxative in 24 hours could have serious side effects, including death. This risk is present for all consumers of sodium phosphate laxatives, but may be higher for certain categories of consumers, including people over 55 years of age, dehydrated individuals, and people with existing kidney or bowel trouble. Individuals meeting these and other criteria should seek the advice of a medical professional before taking even one dose of sodium phosphate laxatives.
The risk posed by sodium phosphate laxatives is to the kidneys and the heart, and symptoms of a laxative-related adverse event include "dry mouth, thirst, reduced urine output, and lightheadedness" (signs of dehydration), as well as "drowsiness; sluggishness; a decreased amount of urine; or swelling of the ankles, feet, and legs" (signs of kidney injury). Individuals experiencing these symptoms should contact a medical professional immediately.
The use of laxatives to treat chronic constipation is problematic, and researchers suggest several alternative remedies. Among these are the use of probiotics and modification of diet. In particular, restricting or eliminating the consumption of gluten and / or short-chain poorly absorbed carbohydrates can have a beneficial effect. These short-chain poorly absorbed carbohydrates are also known as FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols); intolerance of FODMAPs is common, but underdiagnosed. FODMAPs are known to cause distension of the gut lumen, which can result in unpleasant gastrointestinal symptoms.
According to experts in gastroenterology and dietetics, FODMAPs include foods in which fructose content exceeds glucose content, such as pears, apples, and honey; foods containing fructans, such as artichokes, garlic, onions, wheat, and rye; and foods containing sugar polyols, such as "stone fruits" like peaches as well as artificial sweeteners. Eliminating FODMAPs from the diets of intolerant individuals results in "marked improvement of gastrointestinal symptoms." Examining, and potentially altering, the diet of a patient with chronic constipation should be a first-line therapy.