Lactulose

Has anyone played with lactulose, orally or in an enema? If so, what happened?

Its kind of pointless to use it in an enema. If you get an enema, you'll expect the need to expel. If you take it orally, knowingly or unknowingly, it comes out the other end. 😁

I have not used lactulose, although I believe it is a prescription only suppository, mainly used with children.

However, you can also purchase Sorbitol solultion (around 70%) . It is a sweetener and is used in severeal non-sugar candies. One of the side effects for some people is extreme diarrhea.

I have experimented a bit with this and found that 6 ounces of Sorbitol in a pint of warm water makes for a great enema. Bacteria in the colon react to the Sorbitol and produce a lot of gas. It is somewhat slow acting. Walgreen's carries it for about $4.00 per 16 oz.

Sorbitol is about 60 percent as sweet as sucrose with one-third fewer calories. That means you are taking a very high calorie enema depending on how much gets absorbed into your system.

It may have lots of calories, but that turns out to be largely meaningless. Very little gets absorbed or metabolized by the body.

The reality is sorbitol is almost impossible to absorb in substantial amounts, so it exerts considerable osmotic pressure in the intestinal lumen. In short it is a very effective hyperosmotic laxative, and for the same reason, it works as a enema like a Fleet enema.

This is why Sorbitol is used as a sweetnerin reduced calorie foods, and why it is such an effective laxative. If it was readily absorbed, it would not be such an effective laxative.

Most sugar alcohols are very similar in this regard (Mannitol, Lacitol, Maltitol). Prior to the development of the PEG3350 based Colonscopy preps, large doeses of Mannitol were often used.

The laxative dose of sorbitol is generally accepted to be somewhere around .5gm/kg, so if you weigh 70kg (154lbs), 35 grams of more is likely to produce 'results'. Sorbitol is typically a 70% solution, so anything more than about 50grams of 70% solutions is likely to be effective from either end. I believe the FDA require sorbitol sweetened products to carry a warning that 'excessive consumption may cause laxative effect'. Excessive has turned out to a lot less than many expect.

In many people, high doses do produce a lot of gas, which is a result of Bacteria in the bowel breaking down the Sorbitol.

Ebay often has 70% Sorbitol Solutions for sale as well as sorbitol poweder. If you want to buy the powder, make sure it is at least USP grade (not technical).

Sorbitol or lactulose can be added to a small amount of water, about an ounce and a half to six and a half ounces of water and syringed using a bulb syringe. Gas will start forming in the colon right away causing an eventual strong urge to go. The longer the retention, the stronger the urge.

Be careful with using mannitol in an enema. It may not a big deal because I'm fairly sure that it is a rx only item now. I'm a medical setting, mannitol is used to stem off increases in intracranial pressure usually secondary to head trauma. It is quite a potent diuretic and can cause electrolyte imbalances, heart failure, and kidney issues. Perhaps there wouldn't be enough absorption thru the rectum or colon to cause issues. Personally, I think there are far better solutions to use that don't have those side effects.

Be careful with using mannitol in an enema. It may not a big deal because I'm fairly sure that it is a rx only item now. .. . . . .

NO.

Mannitol is readily available and is NOT Rx

Sorbitol caused intestinal obstruction for me.

Similar intestinal obstruction appears to have been reported in animal studies and in some human cases.

If you are trying low molecular weight sugar alcohols for the first time, it is recommended to start with a small amount.

@SwitchableSusie

You wrote: "Its kind of pointless to use it in an enema. If you get an enema, you'll expect the need to expel. If you take it orally, knowingly or unknowingly, it comes out the other end."

Not so. I was given a Lactulose enema (300ml Lactulose, 700ml saline) post surgery. The nurse told to hold it for at least 30 minutes but only made it to about 25 before having a terrific poo. Over the following several hours, I had to poo very urgently several more times. The nurse didn't even try to get me to the bathroom or even onto a bedpan. The enemas and poo just came out onto Chux pads.

The addition of Lactulose makes an enema very powerful in my experience.

I had a lactulose enema in the hospital just a couple of years ago. Long story short, I had pancreatitis and resulting ileus from an EUS and biopsy. This was absolutely no fun. They would not let me go home with an ileus. Two very nice lady GI doctors came in and examined me and conferred. They offered me “the enema of death” as an option to get things moving (I did not tell them I was a klismo). I asked them what that might be and they said lactulose, which I had never heard of. I agreed and they said they would prescribe it. Hours later my nurse comes in with the powder and instructions from the pharmacy on how to prepare and administer it. Let me just say the enema has become a lost art in the modern hospital setting.

I get about 500 cc's of the resulting room temperature solution. The nurse leaves with no further instruction. I'm laying there thinking, ok… enema of death… something should be happening. 30 minutes later - nothing. No urge at all. I eventually decide to go sit on the potty and expel what I could. It was underwhelming. I hoped the nice lady GI docs would come back so I could tell them their enema of death was a dud, but they never did. I am tempted to retry it based on what @Sean said.