From the Guidelines
Senna should not be used in patients with known hypersensitivity to senna, intestinal obstruction, inflammatory bowel diseases, appendicitis, abdominal pain of unknown origin, or severe dehydration, as well as in pregnancy and breastfeeding due to potential risks to the fetus/infant, as stated in the american gastroenterological association-american college of gastroenterology clinical practice guideline 1.
Contraindications to Senna
The following are specific contraindications to senna:
- Pregnancy and breastfeeding (due to potential risks to the fetus/infant) 1
- Children under 12 years old (unless specifically prescribed by a doctor)
- Patients with chronic constipation (as it may lead to dependence)
- Those with electrolyte imbalances, especially potassium deficiency
Mechanism of Action and Side Effects
Senna is a stimulant laxative that works by irritating the intestinal lining, promoting bowel movements 1. While generally safe for short-term use, prolonged use can lead to electrolyte imbalances, dehydration, and dependency. The most common adverse effects for stimulant laxatives like senna are diarrhea and abdominal pain, as seen in studies of bisacodyl and SPS 1.
Recommendations
It's essential to address the underlying cause of constipation rather than relying on laxatives long-term. Always consult a healthcare provider before using senna, especially if you have any pre-existing medical conditions or are taking other medications. The american gastroenterological association-american college of gastroenterology clinical practice guideline recommends the use of senna for short-term use or rescue therapy, with a recommended initial dose of 8.6–17.2 mg daily 1.
From the FDA Drug Label
Warnings Do not use laxative products for longer than one week unless directed by a doctor. Ask a doctor before use if you have stomach pain, nausea or vomiting notice a change in bowel habits that last over two weeks are pregnant or breast feeding Stop use and ask a doctor if you have rectal bleeding or failure to have a bowel movement after use.
The contraindications to Senna are not explicitly stated in the drug label. However, the label advises to ask a doctor before use in certain situations, which can be considered as precautions or warnings, including:
- Stomach pain
- Nausea or vomiting
- Change in bowel habits that last over two weeks
- Pregnancy
- Breast feeding It also advises to stop use and ask a doctor if:
- Rectal bleeding occurs
- Failure to have a bowel movement after use occurs 2
From the Research
Contraindications to Senna
- Intestinal obstruction: Senna can worsen intestinal obstruction, as seen in a case report where a patient developed intestinal obstruction after taking Psyllium husks without adequate fluids 3.
- Inflammatory bowel disease: While Senna may not be directly contraindicated in inflammatory bowel disease, patients with Crohn's disease may have intestinal strictures that can be problematic, and limiting fibrous foods that may cause a mechanical obstruction is helpful 4.
- Pediatric patients with certain conditions: Senna can cause perineal blistering in pediatric patients, especially with high doses or prolonged stool-to-skin contact 5.
- Patients with abdominal pain: High-dose Senna can cause abdominal pain, which may be a concern for some patients 6.
Special Considerations
- Patients with intestinal strictures or inflammatory bowel disease should use Senna with caution and under medical supervision.
- Pediatric patients should be monitored for signs of perineal blistering, and caregivers should be advised to change diapers frequently to reduce stool-to-skin exposure.
- Patients experiencing abdominal pain with Senna may benefit from alternative bowel preparation regimens, such as a combination of half doses of PEG-ES and Senna 6.