Bulk-forming laxatives are made from the dead fibers from plant sources, usually psyllium. Bulk laxatives work by increasing stool mass to the point the bowels force it out. Under healthy circumstances, fiber and increased stool mass can be beneficial. But, if someone is using a bulk laxative, they may not be experiencing optimum health. Furthermore, the use of bulk laxatives has been associated with serious side effects.
Why Do People Take Bulk-Forming Laxatives?
Bulk laxatives, like most laxatives, are taken to address constipation. Constipation is a common problem that can be caused by a range of factors, including illness, slow colonic transit, or pelvic floor dysfunction. According to the Department of Medicine at the University of Chicago Medical Center, other contributing factors include a lack of dietary fiber, not enough fluids, immobility, and medication. 
Most people experience constipation at one point, but as a chronic issue, it is especially common among the elderly and pregnant women. The Division of Geriatric Medicine at Saint Louis University reports that laxative use increases with age.  Constipation during pregnancy affects almost 40% of pregnant women.  As an overall problem, some estimates figure chronic constipation affects the quality of life for as much as one quarter of the population in western countries. 
Bulk Laxatives are Not the Answer to Constipation
The use of laxatives is widespread in North America, extending to hospitals and long-term care facilities. However, evidence supporting the efficacy of some laxatives is limited. In fact, many people report dissatisfaction with the efficacy of traditional laxatives and side effects are a massive concern. Bulk laxatives, specifically, present health concerns that should not be overlooked.
Dangers of Bulk-Forming Laxatives
- The Harry S. Truman Memorial Veterans Hospital has cited the use of bulk laxatives as a cause for dehydration requiring hospitalization. 
- Fiber and bulk laxatives may cause bloating to worsen. 
- Bulk-forming laxatives are not recommended for people at risk for dehydration. 
- Occupational exposure to psyllium is known to cause allergies in healthcare and pharmaceutical workers. 
- According to the Department of Medicine at St. Thomas Hospital in Nashville, bulk laxatives formulated as granules may adhere together and make impaction even worse. 
- Allergic reactions to psyllium can be life threatening. Examples of such reactions have been reported by the University of Toronto and Loyola University Stritch School of Medicine.  
- In a final ruling, the Food and Drug Administration has taken the position that over-the-counter, granular laxatives that contain psyllium ingredients are not generally recognized as safe and effective! 
Alternatives to Bulk Laxatives
Although constipation is a frequent complaint, the use of bulk laxatives is rarely appropriate! Increases in physical activity, fluid intake, and dietary fiber may be sufficient to control constipation. If those methods are inadequate, a safe and gentle oxygen-based colon-cleansing product can help provide relief from constipation.
- Dr. Edward F. Group III, DC, ND, DACBN, DCBCN, DABFM
- Alessi CA, Henderson CT. Constipation and fecal impaction in the long-term care patient. Clin Geriatr Med. 1988 Aug;4(3):571-88. Review.
- Tariq SH. Constipation in long-term care. J Am Med Dir Assoc. 2007 May;8(4):209-18. Review.
- Vazquez JC. Constipation, haemorrhoids, and heartburn in pregnancy. Clin Evid (Online). 2008 Feb 20;2008. doi:pii: 1411.
- Krammer H, Schlieger F, Singer MV. [Therapeutic options of chronic constipation]. Internist (Berl). 2005 Dec;46(12):1331-8. Review. German.
- Wakefield BJ, Mentes J, Holman JE, Culp K. Risk factors and outcomes associated with hospital admission for dehydration. Rehabil Nurs. 2008 Nov-Dec;33(6):233-41.
- Choi MG. [Management of irritable bowel syndrome]. Korean J Gastroenterol. 2006 Feb;47(2):125-30. Review. Korean.
- Klaschik E, Nauck F, Ostgathe C. Constipation–modern laxative therapy. Support Care Cancer. 2003 Nov;11(11):679-85. Epub 2003 Sep 20. Review.
- Bernedo N, García M, Gastaminza G, Fernández E, Bartolomé B, Algorta J, Muñoz D. Allergy to laxative compound (Plantago ovata seed) among health care professionals. J Investig Allergol Clin Immunol. 2008;18(3):181-9.
- Schneider RP. Perdiem causes esophageal impaction and bezoars. South Med J. 1989 Nov;82(11):1449-50.
- Sussman GL, Dorian W. Psyllium anaphylaxis. Allergy Proc. 1990 Sep-Oct;11(5):241-2.
- Lantner RR, Espiritu BR, Zumerchik P, Tobin MC. Anaphylaxis following ingestion of a psyllium-containing cereal. JAMA. 1990 Nov 21;264(19):2534-6.
- Food and Drug Administration, HHS. Laxative drug products for over-the-counter human use; psyllium ingredients in granular forms. Final rule. Fed Regist. 2007 Mar 29;72(60):14669-74.