By John C. Wolf, D.O.
Associate Professor of Family Medicine
Ohio University College of Osteopathic Medicine

HABIT, NOT EFFECTIVENESS, EXPLAINS LOYALTY TO CARTER'S PILLS

Question: I've been told by my pharmacist that Carter's Little Pills" are no longer made. I previously took them for occasional constipation and found them quite effective. If they are still manufactured, where can I purchase them, and if they are no longer made, what can I get that would work the same?

Answer: Those in marketing play upon our tendency to buy products that previously worked for us. I have a friend who wouldn't consider buying a Ford because he has always driven Chevy's. That doesn't imply anything about the quality of either company's respective vehicles. Instead it speaks to the strong tendency for most of us to do things in a predictable, comfortable manner. I usually park in the same place when I can, and I come home using the same route. The process of selection of a non-prescription drug is affected by these same tendencies. That is why you cared enough about Carter's Little Pills to write me instead of just trying a different product.
My local pharmacies no longer carry Carter's Little Pills, but I found them on the internet from a number of sellers. I don't know if the product is actually still in production but with a limited distribution, or if the internet sources are just selling off old stock.
Carter's Little Pills once were sold as Carter's Little Liver Pills. When it was marked under this label its main active ingredient was a stimulant laxative cascara, which is made from the dried bark of a shrub native to North America. Some years ago "Liver" was dropped from the name because it contained no liver nor did it have action on the liver. The more recent product -- Carter's Little Pills (sans liver) -- still contains a stimulant laxative, but now it is bisacodyl.
Laxatives are divided into categories based on how they bring about a bowel movement. Laxatives that increase the frequency and vigor of colon contractions are called stimulant laxatives. Bisacodyl is a common product in this category that is sold under many brand names including Carter's Little Pills. Stimulants usually produce a bowel movement fairly soon after they have been taken. The "down" side to using them is that they can cause uncomfortable colon cramping as part of their action. In addition, regular use of a stimulant laxative tends to make the colon "lazy" so that it contracts very feebly without the aid of the stimulant. This perpetuates the "constipation-laxative-constipation-laxative" cycle.
Fiber-containing products increase the amount of bulk in the stool. When fiber is consumed with sufficient water it produces what a physician friend of mine, who specializes in geriatrics, calls "big fluffy poops." That is, the stools have larger bulk and a softer consistency than they would have otherwise. This is an excellent form of laxative for chronic use because it has no undesirable side effects.
Saline agents comprise another common group of laxatives. These products are salts that are not absorbed by the intestine. The body secretes a large amount of water into the intestine to dilute them, and this action moistens the stool. The amount or water and resultant laxative effect are directly related to the amount of product that is taken. Milk of magnesia and phosphosoda are common examples of this type. The action of a saline agent is usually mild and predictable.
Of course there is more to the complete story about laxatives, but I think I've covered enough for now. Remember that you are not constipated unless you have had no bowel movement for one week or the stool you do pass is hard and dry. If you fit this definition and have been eating a high fiber diet, consuming sufficient liquids and getting regular exercise -- well then, you probably would feel better if you tried a laxative. I'd suggest that you choose by type of laxative rather than by brand name.

"Family Medicine" is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701. Past columns are available online at http://www.FamilyMedicineNews.org.