In 1988, my pharmacy colleague at CAST (now UTech), Leslie-Ann Dixon Kelly and I embarked upon a research project. We undertook this project out of curiosity about the frequent purchase of laxatives (also called 'wash-out') and the experiences of our older friends and relatives during their childhood years.
Twenty years hence, I am still intrigued about the practice of Jamaicans to use laxatives regularly. I am convinced that a similar study today would reveal almost the same results as those of 1988.
Lack of attention to defecate
Constipation is the heritage of civilisation. It is frequently attributed to poor dietary habits, lack of bulk-producing foods in our diet and lack of attention to our bowels' urges. This lack of attention might be due to poor toilet facilities, shift working and the fast pace of life. The longer faeces remain in the rectum, the drier and harder they become.
Drugs like codeine (found in cough syrups and pain killers) and morphine (pain killer for severe pain), which are also useful in anti-diarrhoea preparations, iron preparations, some antacids and drugs for hypertension might cause constipation. Caffeine and alcohol are usual suspects too. Insufficient consumption of water, fruits and vegetables, lack of exercise and rushed or irregular meals are other causes of constipation.
Older folk used laxatives
In 1988 our research revealed that older Jamaicans (over 55 years) were the main users of laxatives, followed by younger adults (26 to 35 years). This result could be due to older Jamaicans being poorer both in finances and health, resulting in changes in their diet, their use of multiple medications, immobility and lack of exercise. Insufficient teeth to chew fibrous foods in the older group may have also contributed to constipation and subsequent laxative use.
Jamaicans reportedly used laxatives to clean out the system, wash out cold, wash out live worms, for personal hygiene and, of course, to relieve constipation. We concluded that since faeces were unpleasant and seemingly poisonous, people felt that getting rid of them as fast as possible would promote health, hence the excessive use of laxatives. Most of those interviewed felt that it was necessary to routinely give a child laxatives for the same reasons stated above, and for bellyache, to control bad eating habits, for tradition (to continue practices of their own parents), to stimulate the appetite of the child and for proper growth.
Laxatives for menstrual cramps
My colleague and I were surprised that some female respondents used laxatives every month to relieve menstrual cramps. They reported that each time they had a bowel movement during their period, the menstrual pains would ease. So, they actually induced the bowel movements with laxatives at that time each month.
Home remedies and commercial laxatives
Back in 1988, those interviewed reported that the home-prepared laxatives used were cerassee tea, aloe vera juice, 'herb' tea, sandback pod, corkscrew leaf, senna pods and bitter wood (bark of Quassia). The commercial laxatives were reportedly used more widely and included Epsom salts, Benjamin's herbs, Indian root pills with mojo herbs, sulphur bitters, Brooklax chocolate laxatives, Andrew's Salts, milk of magnesia, Senokot tablets, castor oil, Glauber salts, black pills, and the list goes on.
We interviewed 30 doctors and 48 pharmacists most of whom felt that laxatives were abused by Jamaicans. Doctors only prescribed laxatives when straining would aggravate other medical conditions such as heart conditions or when straining would cause haemorrhoids to bleed more, or to clear the bowels before surgery or tests such as x-rays and ultrasound.
Fast forward to 2008
My next article will cover laxatives available in Jamaica today. Interestingly, recommendation 2 of that 1988 study was that there should be newspaper articles to inform the public about types of laxatives on the market, their legitimate use and side effects. Well, here we are 20 years later. Who would have thought? Go figure.
Dahlia McDaniel is a pharmacist and final year doctoral candidate in public health at the University of London; email: firstname.lastname@example.org.