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Senna is a laxative available over the counter all over the world.

Senna is a laxative medication that’s used very frequently in clinical practice but is also in many countries around the world including the united kingdom available and over-the-counter medication it is derived from a plant called the senna plant and each tablet of senna contains seven point five milligrams of the active ingredient which is senna sides it should

Be used ideally only as an as required medicine so as a prn medicine rather than a regular i take this everyday medication and it can be taken multiple times a day if necessary however again it should ideally only be taken once a day so the usual dose is to take 15 milligrams or two center tablets when required to relieve constipation however if 15 milligrams

Isn’t enough if that isn’t doing the trick then larger doses can be used so 30 milligrams or force and the tablets can be taken in a single dose to relieve constipation finally in clinical practice we do even use larger doses so we use a dose of 60 milligrams which is 8 than the tablets to prepare people for endoscopic bower procedures so say someone is having

A flexible sigmoidoscopy which is a camera up the back passage to examine the sigmoid colon which is one of the final portions of the colon to prepare someone for this procedure obviously in order for the camera to be able to see anything that portion of the bowel needs to be empty so what we do is from the afternoon the day before the procedure is going to be

Done we stop the person from eating anything further and we don’t need to clear out the content that’s already there so we give them a dose of senna which as we’ll discuss later is a stimulant laxative and the dose that we give them is actually 60 milligrams so they take back the afternoon prior it works over the subsequent hours it takes quite a while to work

Usually about 10 hours we’ll discuss why in just a moment but it helps to clear all the contents from the the cove on that is already there and then just prior to the procedure they usually have an enema on top of the stimulant laxative given the day before and that ensures that the sigmoid colon is completely clear for when they want to perform the procedure so

Doses of 60 milligrams are used clinically i have never seen doses higher than 60 milligrams be given before and if you’re going to take multiple daily smaller doses of senna i would not let the cumulative dose exceed 60 milligrams in a 24-hour period so i would not take more than eight of these tablets within a 24-hour period you will regret it it’s a stimulant

Laxative it irritates the colon that’s the way that it works and it can cause a lot of abdominal pain and even colonic cramps which are they painful so let’s discuss that further so senna is a stimulant laxative so the tablets are taken or they they go through the stomach they go through the small bowel and they do not actually irritate and stimulate the stomach or

Irritate and stimulate the small bowel and the reason for that is that they are not activated into the active form until they get to the colon so once the active ingredient finally arrives in to the colon it gets activated into the form where it can irritate the wall of the bow it then proceeds to irritate the wall of the colon and thereby increases colonic motility

Increased colonic motility is going to result in the luminal contents of the colon being moved through the colon quicker and therefore is going to result in quicker defecation and if content is moving quicker through the codon there’s less time for absorption of water and therefore the contents that is going to be passed is going to be more liquidy note that it

Takes time for this medicine to have an effect so it’s going to be taken orally it will go into the stomach it has to move through the stomach move through the small bowel get into the colon and be activated into the active form once it reaches the colon that takes time usually around 10 hours so you’re not actually going to experience any of the effects of this

Medicine until at least ten hours after actually taking it a lot of people have this preconception about laxatives that they are taken and then they have an immediate effect so after 10 minutes of taking them you’ll be rushing to the toilet that’s certainly not the case for senna it takes at least 10 hours for it to actually take any effect and all those first 10

Hours you won’t feel any difference whatsoever whilst senna is a very effective laxative it’s not a particularly popular laxative among the people who actually are given it it’s not a medication that people take and say wow that’s lovely that’s made me feel so great please give me some more and the reason for that is one it doesn’t taste particularly nice remember

It comes from this plant the senna plant and the tablets themselves taste like that plant so it tastes kind of like a weird herbal tea so unless you like that flavor which most people don’t you’re not going to enjoy the sensation of taking the tablet in addition because it works as a stimulant laxative and worked by irritating the wall of the colon an increase in

Chronic motility it can cause point a lot of pain once it actually starts to take effect so after 10 hours of taking it when it’s actually stimulating the colon you can get quite a lot of crampy abdominal pains from the increased motility that it’s driving and that’s why really you only want to be using this medicine as required to relieve constipation rather than

Taking it on a daily basis it’s a laxative that we use a lot in hospital especially when we have patients on opiates so i work in orthopedics at the moment and a lot of the patients are on opiates to relieve the pain of their broken bones and post-operative pain opiates inhibit gi motility and therefore one their major side effects is that they can lead to vap

Bad constipation to try to relieve this one of the things that we do do is we put them on daily center whilst they’re going to be on the high strength gets so usually we put them on 50-milligram once a day and we usually get them to take it just before they go to bed on the grounds that it’s going to then take ten hours to get actually into the colon into its

Active form in that ten hours they can happily be asleep and then by the time it actually takes effect and they’re going to be needing to go to the toilet it’ll be the next morning and they’ll be awake again and we do that to try to prevent them needing to go to the toilet in the middle of the night but we’re only prescribing them daily center for a short-term

Period whilst they’re on the high strength opiates once they come off the high strength opiates then we’ll all stop the daily center medication as well as i’ve said multiple times throughout the video ideally it’s not a medicine that you want to be taking regularly on a daily basis for a long period of time if someone has chronic constipation ideally that should

Be treated firstly by increasing dietary fiber intake both soluble and insoluble fiber and if that doesn’t work then adding a fiber supplement laxatives such as it’s begorrah husk fiber gel you ideally don’t want to be putting them on a daily stimulant laxatives if however you cannot get on top of their constipation it might be something that they do end up having

To take and you do see people tip of with daily prescriptions of senna and sometimes it is necessary

Transcribed from video
Senna By Elliot Nicholson