Dried senna leaflets, the main part used, and senna tea (illustration).

Herbs & Botanicals · Herbs · Leaf and pod laxative, with moderate evidence for short-term constipation and firm limits on how long to use it

Senna

Q: Does senna work for constipation?

Yes, for short-term constipation in adults, with moderate certainty. In one 28-day placebo-controlled trial of 90 adults, 69.2% improved on senna against 11.7% on placebo. A review graded it as good evidence, but that review was paid for by a laxative maker and the trial is small. For other groups the evidence is weaker.

Q: How long is it safe to use senna?

Only briefly. The EU herbal monograph says not to use senna leaf for more than 1 week, and that two to three uses in that week are usually enough. Longer use may lead to dependence on laxatives and to potassium loss. If you need a laxative every day, see a doctor to find the cause. Ask a doctor or pharmacist about amounts.

Q: Is senna addictive, and will it make my bowel lazy?

The EU monograph warns that long use may lead to impaired bowel function and dependence on laxatives. Reviews looked for lasting nerve or muscle damage and found no convincing evidence, and a children's review found no tolerance, but long-term trials are missing. The safe course is to follow the short-term limit.

Q: Which medicines does senna interact with?

The EU monograph names heart medicines called cardiac glycosides (such as digoxin), heart rhythm drugs, medicines that prolong the QT interval, water pills (diuretics), steroid tablets and licorice root. Senna can lower potassium, and low potassium makes these drugs act differently. A Taiwanese study linked sennosides to a 1.61-fold higher chance of digoxin toxicity. Ask a doctor or pharmacist first.

Q: Is senna safe in pregnancy or when breastfeeding?

The EU monograph contraindicates it in both, citing genotoxic findings for related compounds and small amounts of rhein in breast milk. Other sources disagree: the US LactMed abstract says usual doses are acceptable while breastfeeding, and one review called senna a safe laxative in pregnancy. Because the advice differs, talk to a doctor or midwife.

Q: Can children take senna?

The EU monograph says not under 12 for the herbal product. Children's doctors do prescribe senna, but evidence is thin: a Cochrane review found only one small senna trial. Nappy-area blistering can occur and was seen in 2.2% of 640 children at one centre. Do not give senna to a child without medical advice.

Q: Can senna damage the liver?

Rarely, and at high doses over long periods. LiverTox says injury can occur when used in high doses for longer than recommended, and cases include a woman who drank 1 L a day of senna pod tea for over 3 years. How often it happens is not known. Stop and see a doctor for yellow skin or eyes or dark urine.

Q: Does senna cause colon cancer or melanosis coli?

Melanosis coli, a harmless dark staining of the colon lining, is common with long use and usually fades after stopping (one case resolved in 7 months). Cancer: senna did not cause tumours in a 2-year rat study or in a 40-week study in p53 mice, and a 2022 meta-analysis of studies found no statistically significant link (OR 1.41, 95% CI 0.94 to 2.11), though the authors want better studies. Some related compounds were genotoxic in lab tests.

Q: Does senna work for cleaning the bowel before a colonoscopy?

It can, with mixed results. A meta-analysis of 11 trials found cleanliness similar to other preparations with better tolerance, but belly pain was common and some trials favoured PEG or newer combinations. In children, PEG was better. Your endoscopy team chooses the preparation.

Q: Is senna good for constipation caused by opioid painkillers?

It is widely used, but trials are small. In 70 cancer outpatients PEG gave slightly more satisfactory days than sennosides, which the authors called weak evidence. Reviews could not separate laxatives clearly. Ask your care team.

Senna alexandrina Mill. (also called Cassia senna L. and Cassia angustifolia Vahl) · also called Senna, Alexandrian senna, Indian senna, Tinnevelly senna, sena (Spanish), séné (French), Sennesblätter (German), 番泻叶 fānxièyè (Chinese)

Senna is a small shrub whose dried leaflets and pods are used as a stimulant laxative. Its active compounds are sennosides A and B, which gut bacteria turn into a form that speeds the large bowel and draws water into it. Evidence is moderate for short-term constipation in adults (one placebo-controlled trial and a review that was paid for by a laxative maker), low for constipation in older people, opioid-induced constipation, bowel cleaning before colon surgery and after childbirth, mixed for colonoscopy and capsule-camera preparation and for recovery after surgery, very low for children and for people with kidney disease or in intensive care, and against senna alone for colonoscopy preparation in children. The EU herbal monograph allows senna leaf only for short-term occasional constipation, for no more than 1 week, and says not to use it in pregnancy, breastfeeding, under age 12 or with a blocked bowel. Long use can cause dependence, loss of potassium, dark colon lining (melanosis coli) and, in rare reported cases at high doses, liver injury; potassium loss can add to heart medicines, water pills, steroids and licorice. Animal studies of senna did not find cancer, but some related compounds were genotoxic in lab tests and the human data are mixed.

General information, not medical advice. Last substantive update October 25, 2026 · Not medically reviewed. A named clinician has not signed off on this page. How this page is made

About Senna

Senna is a shrub whose dried leaflets and pods are a stimulant laxative. It has moderate evidence for short-term constipation in adults and low, mixed or weaker evidence for other uses. The EU allows senna leaf only for short-term occasional constipation, for no more than 1 week, and not in pregnancy, breastfeeding or under age 12. Long use can cause dependence, potassium loss, dark colon lining and, in rare reported cases of high doses, liver injury.

What it is

Senna (Senna alexandrina Mill., also written Cassia senna L. or Cassia angustifolia Vahl) is a small shrub in the legume family. The dried leaflets and the pods are the parts used. Two kinds are sold, Alexandrian senna and Tinnevelly senna, and both come from the same species today.

Do not mix it up with other plants. Senna italica is a different species, and the seeds of Senna occidentalis are poisonous and have caused serious liver, muscle and brain damage in children.

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Traditional and current uses

Senna is a stimulant laxative. The EU herbal committee accepts senna leaf for short-term use in occasional constipation (well-established use), for adults and for adolescents over 12. It says to use it only when a change of diet or a bulk-forming fibre has not worked.

Doctors and hospitals also use senna with opioid painkillers, before colonoscopy, and after some operations or childbirth. Trials of these uses are covered below. No trial supports senna for weight loss or 'detox'.

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What is in it and how it works

Senna's active compounds are sennosides A and B. They pass through the stomach and small bowel unchanged. Bacteria in the large bowel turn them into rheinanthrone, which speeds the bowel and makes the lining leakier to water, so more fluid stays in the stool. A bowel movement usually follows 8 to 12 hours later.

Rhein, a breakdown product, reaches the blood in small amounts and passes into breast milk in tiny amounts. Related compounds such as emodin and aloe-emodin have shown genotoxic effects in some lab tests, which is part of the EU reason to avoid senna in pregnancy.

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What the research shows

The clearest result is for short-term constipation in adults: in a 28-day trial of 90 Japanese adults, 69.2% improved on senna, 68.3% on magnesium oxide and 11.7% on placebo. A review graded senna as good evidence but was paid for by a laxative maker. In older people, senna-plus-fibre products did better than lactulose in two 1993 trials.

Other uses have little or mixed evidence. For constipation caused by opioid painkillers, small trials suggest senna works but may be a little less effective than polyethylene glycol. For colonoscopy, senna regimens are as clean as other preparations in a meta-analysis but cause more belly pain in some trials, and in children PEG was better. After operations, regimens containing senna with docusate helped in two trials; senna alone did not help after shoulder surgery. After childbirth, senna may bring the first bowel movement sooner but may cause more cramps.

In children there is almost no good evidence, and in people with kidney disease or in intensive care only three small trials.

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At a glance

Traditional uses history, not proof

Herbal laxative: the EU lists senna leaf as well-established use for short-term occasional constipation.
Used with opioid painkillers in cancer and palliative care, and as a bowel preparation in some countries, as reported in trials.
The traditional history (Arabic and Indian medicine) is not verified in the sources read.

Studied for research

Chronic constipation in adults, moderate
Constipation in older people, opioid-induced constipation, bowel cleaning before colorectal surgery and after childbirth, low
Colonoscopy preparation in adults, capsule endoscopy preparation and recovery after surgery, mixed
Constipation in children and in kidney disease or intensive care, very low
Colonoscopy preparation in children (senna alone), against

Main compounds

Sennosides A and B, dianthrone glycosides that are laxative prodrugs
Rheinanthrone and rhein, the active and absorbed metabolites made by gut bacteria
Aloe-emodin and emodin, related compounds with genotoxic findings in some lab tests

Common forms

Dried leaf as a tea
Standardised leaf or pod extracts in tablets and liquids
Purified sennosides (calcium sennosides) and combinations with fibre or docusate

Research links: EU herbal monograph on senna leaf (European Medicines Agency) · Over-the-counter therapies for chronic constipation: updated systematic review (abstract) · Senna versus magnesium oxide for chronic constipation: randomized placebo-controlled trial (abstract) · Cochrane review: interventions for preventing postpartum constipation (abstract) · US National Toxicology Program study of senna in mice (abstract) · Research Library · Genes & Biomarkers Library

The plant and its history

Accepted scientific name: Senna alexandrina Mill.
Naming authority: Mill., published in Gard. Dict. ed. 8: n. 1 (1768) (GBIF, usageKey 2958032, status accepted, confidence 100 on exact name match, retrieved 2026-10-25)
Synonyms: Cassia senna L.; Cassia acutifolia Delile; Cassia alexandrina (Mill.) Spreng.; Senna acutifolia Batka; Cassia angustifolia Vahl (GBIF lists it as a synonym of Senna alexandrina var. alexandrina, key 7302622; NCBI lists it as a synonym of the species); Senna angustifolia (Vahl) Batka (NCBI synonym)
Common names: Alexandrian senna (English); Indian senna (English); Tinnevelly senna (English); Egyptian senna (English); East Indian senna (English); true senna (English); sena alejandrina; sen de España (Spanish); séné (casse) (French); alexandrinische Senna (German); sene (Portuguese); 番泻叶 (fānxièyè) (Chinese); センナ (Japanese)
Botanical family: Fabaceae (the legume or pea family, order Fabales). The older name Cassia for senna is a different genus today; true Cassia (for example Cassia fistula) is separate.
Classification: Plantae > Tracheophyta > Magnoliopsida (dicots) > Fabales > Fabaceae > Senna > Senna alexandrina
Native range: Not verified from a flora in this work. The review by Franz says senna is cultivated in Somalia, the Arabian peninsula and near the Nile (Alexandrian senna), and in South India and Pakistan (Tinnevelly senna).
Habitat: Not verified from a flora. A small shrub of dry regions, cultivated as a crop (Franz review: 'small shrubs of Leguminosae').
What the plant looks like: Roots: Not described in the sources read.; Stems: Small shrub (Franz review).; Leaves: Compound leaves; the dried leaflets (leaf) are the part sold, and the leaflets are narrow and lance-shaped (general description, not checked against a flora).; Flowers: Not described in the sources read.; Fruit: A flat pod (the dried fruits are called senna pods and are also used; the Franz review says pods have the same active constituents in larger amounts).
Cultivation: Grown as a crop; leaf and pods are collected at the same time, and the pods are dried and graded (Franz review). Aflatoxin contamination can develop in the pods at late harvest and in storage (Subramani 2025).
Harvest and processing: The EU monograph describes 'senna leaf' as the dried leaflets (Ph. Eur. monograph 0206) used as a comminuted herbal substance for tea or as standardised preparations. Franz notes damaged leaflets and lower quality material are used for galenical (extract) products.
Look-alikes and adulterants: Name: Senna italica Mill. (Italian or Port Royal senna); Note: A different accepted species (GBIF key 2957095). A lab comparison found a similar chemical profile but lower sennoside A (1.00% vs 1.85% in S. alexandrina) and liver-cell toxicity at high concentrations in both; it is not the same herbal drug as the EU leaf monograph. (p37110216); Name: Senna occidentalis (L.) Link (coffee senna, stinking weed); Note: A different accepted species (GBIF key 2957966). Its seeds contain anthraquinones and cause serious liver, muscle and brain poisoning, mostly in children. Never a substitute. (p33011371); Name: Senna obtusifolia (L.) H.S.Irwin & Barneby; Senna tora; Note: Different species (GBIF keys 2957408, 2957728) used in Asian medicine as cassia seed. Not the laxative leaf. Names are easy to confuse with Cassia.; Name: Cassia fistula L. (golden shower tree); Note: A different species (GBIF key 5357108) not senna and not the laxative leaf; the old shared genus name Cassia makes the two easy to confuse.

The plant and the parts used

Dried senna leaflets beside a cup of senna tea — Dried senna leaflets, the main part used, and senna tea (illustration).

Traditional use and history history, not clinical proof

Tradition or era	Documented use	Source
Modern pharmacy and plant chemistry	The review by Franz says the senna drug is the dried leaflets or fruits of Alexandrian senna and Tinnevelly senna, that the active compounds were first isolated by Stoll in 1941, and that sennoside A and B were identified as dimers of aloe-emodin and/or rhein. Only the abstract (truncated) was read.	p8234429
European regulatory medicine	The EU herbal committee first adopted a monograph on senna on 13 July 2006 (listed as EMA/HMPC/600717/2007) and adopted a revised one on 25 September 2018. It classes senna leaf as well-established use for short-term occasional constipation.	s-ema-hmpc-senna-leaf-2018
United States regulatory attention	The US NTP report says the FDA nominated senna for study because use was expected to rise after the stimulant laxatives danthron and phenolphthalein were removed from the market, and because some senna components were genotoxic in vitro and its carcinogenic potential was unknown.	s-ntp-gmm15-senna
Laxative trials of the 1980s and 1990s	Controlled trials of standardised senna products date from 1980 (after childbirth) and the 1990s (older patients, colonoscopy preparation, colorectal surgery).	p6996138
Arabic and Indian traditional medicine (NOT verified)	Senna is widely described as having been introduced into medicine by Arabian physicians in the early Middle Ages and used in Ayurveda. This was not read in a source for this file and is NOT verified.

Traditional use shows how a plant was used. It does not show that a supplement works or is safe today.

What is inside, and how it may work

What the plant contains and how those compounds act in cells and animals. Laboratory and animal mechanisms are not proven effects in people.

Main compounds

Compound	Family	Where it is concentrated	Activity studied	Level of evidence
Sennoside A PubChem 73111	dianthrone glycoside (anthraquinone family)	Leaf and pod In a methanol extract of Senna alexandrina, 1.85 +/- 0.095% (Zibaee 2023, one analysis)	The main laxative prodrug. It passes the upper gut unchanged; gut bacteria turn it into rheinanthrone. ^{80 78 84}	Authoritative guidance
Sennoside B PubChem 91440	dianthrone glycoside, stereoisomer of sennoside A	Leaf and pod 0.41 +/- 0.12% of the same extract	Laxative prodrug with the same route as sennoside A. ^{80 78 84}	Authoritative guidance
Sennosides C (CID 46173829) and D (CID 46173830) PubChem 46173829	dianthrone glycosides	Leaf and pod Not found	Further sennosides confirmed in the leaf (Franz review). ^{20 84}	Authoritative guidance
Sennidin A (aglycone of sennosides) PubChem 92826	dianthrone	Formed in the gut Not applicable	Aglycone found in blood in small amounts with rhein (EU monograph). ^{80 84}	Authoritative guidance
Rheinanthrone (rhein anthrone) PubChem 119396	anthrone (active metabolite)	Formed in the large bowel by bacteria Not applicable	The active laxative metabolite: speeds colon movement and makes the gut lining leakier to water. ^{80 35 84}	Authoritative guidance
Rhein PubChem 10168	anthraquinone	Formed from rheinanthrone by oxidation Plasma up to 150-160 ng/ml in 10 volunteers (Krumbiegel 1993); 100 ng/ml after 20 mg sennosides for 7 days (EU monograph)	Absorbed metabolite; small amounts reach breast milk; mutagenic in some bacterial tests (NTP). ^{80 29 18 83 84}	Authoritative guidance
Aloe-emodin PubChem 10207	anthraquinone	Part of the sennoside molecule; free forms in small amounts Not detectable in human plasma after therapeutic senna doses (Krumbiegel 1993)	The EU monograph names aloe-emodin and emodin among anthranoids with genotoxic findings in lab tests (not proven in living systems for aloe-emodin). ^{80 29 84}	Authoritative guidance
Emodin PubChem 3220	anthraquinone	Named as a component of senna products in a 1997 review Not found	Genotoxic in some lab tests; a 1997 review (Brusick and Mengs) says emodin and aloe-emodin were the senna-product components that gave some positive genotoxicity results. ^{8 80 84}	Laboratory research
Flavonoid glycosides, naphthalene glycosides (6-hydroxymusicin glucoside, tinnevellin glucoside) and other minor compounds	flavonoid glycosides and naphthalenes	Leaf and pod Not found	Minor constituents; the naphthalene glycosides can distinguish Alexandrian from Tinnevelly senna (Franz review); PubChem CIDs were not looked up. ^{20 78}	Authoritative guidance

Mechanisms, receptors and pathways

Target or pathway	Gene or receptor	What was found	Level
Bacterial activation of sennosides in the large bowel	Gut bacteria (including Bifidobacterium and Peptostreptococcus intermedius)	The EU monograph says sennosides are not absorbed in the upper gut or split by human digestive enzymes; large-bowel bacteria convert them into rheinanthrone, so the effect starts 8 to 12 hours after a dose. Lab work with human gut bacteria isolated an enzyme from Peptostreptococcus intermedius that helps reduce sennosides to rhein anthrone, and in mice some Bifidobacterium strains broke down more than 70% of sennoside and increased gut transit. ^{80 23 35}	Authoritative guidance
Stimulated colon movement	Colon motility (migrating long-spike bursts)	The EU monograph describes faster colonic transit. A small 1988 human study with sensors in the colon found more propulsive activity after sennosides. ^{80 63}	Authoritative guidance
Fluid and salt movement into the bowel	Epithelial sodium and chloride transport; tight junctions	Rheinanthrone blocks absorption of water and salts (sodium, chloride) into colon cells, makes tight junctions leakier and stimulates secretion, so more fluid stays in the bowel. ⁸⁰	Authoritative guidance
Aquaporin water channel activity	Aquaporins (Aqp1 to Aqp11) in colon, kidney and liver	In rats with diarrhoea, sennosides lowered aquaporin gene expression in the colon, whereas whole senna extract raised it in kidney and liver and increased kidney and liver weight. The authors advise caution with chronic use in kidney or liver disease. ¹²	Animal research
Colon lining cell loss and renewal	Colon epithelium; p53 and bcl-2 expression	In 32 people, a single high dose of purified senna extract made colon crypts shorter and cell proliferation higher, with no difference in p53 and more bcl-2 where crypts were shorter; the authors suggest apoptosis with compensatory renewal as a possible route for the suggested cancer-promoting effect of chronic use. A review links apoptotic cell bodies to the pigment of melanosis coli. ^{86 85}	Human data
Colon and caecum lining thickening (hyperplasia)	Colon and caecum epithelium	Reversible in rats and mice at high or long doses: NTP found colon and caecum hyperplasia at 10,000 ppm in p53 mice; the rat study found mild hyperplasia in all treated groups. ^{83 37 80}	Animal research
Kidney changes at high doses	Kidney tubules	Rats given senna pods had dark kidneys with tubular pigment deposits and tubular basophilia; the EU monograph says these changes were reversible but pigment partly remained after recovery. ^{37 80}	Animal research
Genotoxicity in lab tests	DNA damage (Ames test)	Some senna samples and rhein were mutagenic in some Salmonella strains; sennosides A and B were not. The EU monograph says this was not proven in living systems for senna. ^{83 80 8}	Laboratory research
Skin irritation from stool	Skin	Stool containing senna metabolites on skin causes irritant blistering in nappy-wearing children. ^{72 46}	Human data
Reduced absorption of a licorice compound	Intestinal absorption	In rats, sennoside A, sennidin A and rhein lowered the absorption of glycyrrhetic acid from licorice. ³⁸	Animal research

Absorption, metabolism and elimination

Absorption: Sennosides are not absorbed in the upper gut. Bacteria in the large bowel convert them to rheinanthrone (EU monograph); in animal experiments less than 10% of rheinanthrone placed directly in the caecum was absorbed. Rhein and sennidins reach the blood mainly as glucuronides and sulphates.
Distribution: In human plasma, rhein reached 150-160 ng/ml with two peaks (3-5 h and 10-11 h after dosing); aloe-emodin was not detectable (10 volunteers, two senna products). The EU monograph says placental passage of rhein is low in animals and small amounts pass into breast milk.
Metabolism: Rheinanthrone is oxidised in contact with oxygen to rhein and sennidins (EU monograph). The sennoside-reducing enzyme from gut bacteria has been isolated in the lab.
Elimination: After oral sennosides, 3-6% of the metabolites are excreted in urine and some in bile; about 90% of sennosides leave in the faeces as polymers (polyquinones), with 2-6% as unchanged sennosides, sennidins, rhein anthrone and rhein. After 7 days of senna pod powder (20 mg sennosides) a maximum of 100 ng rhein/ml was found in the blood, with no accumulation.
Bioavailability: Low for the active forms; rhein appears in blood but the laxative effect is local in the colon. Breast milk: in 20 women on 15 mg sennosides a day, 94% of milk samples had rhein below 10 ng/ml (about 0.007% of the dose).

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Isolated compounds versus whole extracts

Senna products range from the whole dried leaf or pods (tea), to standardised leaf or pod extracts, to purified sennosides (calcium sennosides). The EU monograph covers comminuted leaf or standardised preparations measured as hydroxyanthracene derivatives (calculated as sennoside B) and notes there are no preclinical data on the leaf, so pod data are transferred to it. In a rat study, whole senna extract affected the kidneys and liver (weights, aquaporin gene activity) more than purified sennosides, which acted mainly on the colon. Most trials do not say which form or plant part they used, which limits how results can be compared.

Nutritional composition

Senna is a medicinal herb, not a food, so no food-nutrient table applies and none was looked up (no USDA FoodData entry was checked). It is not a meaningful source of vitamins or minerals. Its main compounds are sennosides (dianthrone glycosides) and flavonoids, not nutrients.

11benefits and uses looked at

86studies and sources checked

Moderate certaintybest evidence rating found

8lab markers tracked in trials

1 moderate certainty3 mixed findings4 low certainty2 very low certainty1 evidence against

What was looked at

The 11 benefits and uses checked for Senna, each with how strong the evidence is. Tap one to open it.

Chronic constipation in adults: more bowel movementsModerate certainty
Constipation in older people in care homes and hospitalsLow certainty
Constipation in children, including after bowel surgeryVery low certainty
Constipation caused by opioid painkillers (cancer care, palliative care, after surgery)Low certainty
Constipation in people with kidney disease or in intensive careVery low certainty
Cleaning the bowel before a colonoscopy (adults)Mixed findings
Cleaning the bowel before a colonoscopy (children and young people)Evidence against
Preparing the bowel for capsule endoscopy (swallowed camera)Mixed findings
Cleaning the bowel before colon or rectal surgeryLow certainty
Constipation and slow bowel recovery after surgeryMixed findings
Constipation after giving birthLow certainty

Lab markers tracked in the studies

Spontaneous bowel movements per weekConstipation symptom and quality-of-life scores (PAC-SYM, PAC-QOL)Need for enema, extra laxatives or an X-rayFaecal loading on abdominal X-ray (Leech score)Bowel cleanliness score (Boston Bowel Preparation Scale and others)Adenoma detection rateTime to the first bowel movement or return of gut functionSmall-bowel cleansing for capsule endoscopy

What is Senna good for?

The main proposed uses and how strong the human evidence is for each. Only adult constipation reaches moderate. 'Low' means the trials point one way but are small or uneven; 'mixed' means trials disagree; 'against' means the trials point against it.

Chronic constipation in adults: more bowel movementsModerate certaintyIn the one placebo-controlled trial of 90 adults, about 7 in 10 people improved on senna (69.2%) against about 1 in 10 on placebo (11.7%) over 28 days, about the same as magnesium oxide. A 2021 review graded senna as good evidence, but that review was paid for by a laxative maker and the trial is small. Constipation in older people in care homes and hospitalsLow certaintyTwo 1993 trials of senna-plus-fibre products in long-stay older patients found more bowel movements than with lactulose and similar side effects. A 2018 review of 7 trials found no serious side effects but said long-term results are unproven. Constipation in children, including after bowel surgeryVery low certaintyA Cochrane review found only one small senna trial in children. Two tiny trials in children with repaired anorectal malformations disagree, and blistering in the nappy area is a known side effect. The EU monograph says senna leaf must not be given under 12. Constipation caused by opioid painkillersLow certaintySenna is widely used, but trials are small. In 70 cancer outpatients polyethylene glycol (PEG) gave slightly more satisfactory days than sennosides (weak evidence), and reviews could not separate laxatives. Senna did as well as lubiprostone after orthopaedic surgery in 64 adults. Constipation in kidney disease or intensive careVery low certaintyThree small trials: senna plus husk matched lactulose in 22 people with kidney disease, bisacodyl produced more bowel movements early in 70 intensive-care patients, and in dialysis senna was the comparator for a peritonitis outcome. Cleaning the bowel before a colonoscopy (adults)Mixed findingsA meta-analysis of 11 trials found no difference in bowel cleanliness between senna regimens and others, with better tolerance but more belly pain in some trials. Individual trials favour senna, PEG, sodium phosphate or newer combinations depending on the comparison. Cleaning the bowel before a colonoscopy (children)Evidence againstThree trials (318 children) found PEG better than senna and less painful (RR 1.35 for good preparation; certainty low to moderate), so senna is not the preferred choice. Preparing the bowel for capsule endoscopyMixed findingsOne trial found senna with magnesium citrate no better than standard preparation and less comfortable; another found senna with fasting improved cleaning of the lower small bowel; a meta-analysis linked adjunct laxatives to better colon capsule cleaning. Cleaning the bowel before colon or rectal surgeryLow certaintyOne 1999 trial of 523 patients found senna cleaned the bowel better than PEG without more infections or leaks. Constipation and slow bowel recovery after surgeryMixed findingsRegimens containing senna with docusate (and macrogol) shortened the time to first stool by about 1 day in two trials, but senna alone did not help after shoulder surgery in a third. Constipation after giving birthLow certaintyA Cochrane review found senna may bring the first bowel movement within 24 hours more often (low certainty) but may raise cramps; evidence is old and the EU monograph advises against use in breastfeeding.

Benefits, one by one

Each card is a research question, not a promise. Tap a goal to filter. Open a card to see the studies, doses and limits.

Chronic constipation in adults: more bowel movements

Moderate certainty

Senna probably helps adults who have long-standing constipation to go to the toilet more often. In the one placebo-controlled trial, about 7 in 10 people on senna improved, compared with about 1 in 10 on placebo.

4 studiesSenna product not specified in the abstracts (leaf or pods unspecifie…

Studies, doses and limits

What the trials found

A 28-day double-blind placebo-controlled trial in 90 Japanese adults with chronic idiopathic constipation (Morishita 2021) compared senna 1.0 g a day, magnesium oxide 1.5 g a day and placebo. Overall improvement was 69.2% with senna, 68.3% with magnesium oxide and 11.7% with placebo (P < 0.0001), and bowel movements and quality of life improved more than with placebo. A 2021 systematic review of over-the-counter constipation treatments (Rao and Brenner, 41 trials of at least 4 weeks) gave a grade A recommendation for senna and for polyethylene glycol, but that review was paid for by the maker of a laxative (Bayer). An earlier review (Ramkumar and Rao 2005) found too few quality trials of senna to grade it.

Results

Senna beat placebo in the one placebo-controlled trial. Reviewers rate it among the first-line choices, but the review was industry-funded and the best trial is small.

Effect sizes as reported

Overall improvement 69.2% senna vs 11.7% placebo (P < 0.0001); similar to magnesium oxide (68.3%). Review grade: A (good evidence) for senna.

Why this rating

One well-run placebo-controlled trial gives a large effect, and a review graded senna as good evidence. But the trial is small (90 people, mostly women, 28 days), the review was industry-funded and used its own grading scale, and an older review found too few trials. No formal GRADE rating was given in the abstracts.

Form and dose studied

Senna product not specified in the abstracts (leaf or pods unspecified). The EU monograph sets the allowed use; amounts are for a doctor or pharmacist.

Who was studied

Adults with chronic idiopathic constipation, mostly women (trial); mixed adult populations (review).

Limits

Small single-country trial; short follow-up; funding by Bayer for the review; most trials do not say which part of the plant or which brand was used.

Why researchers looked

Constipation is very common, and senna is one of the most widely sold stimulant laxatives. It is used for the occasional case and for people who have not got relief from fibre and fluids.

Traditional use

Senna leaves and pods have a long history as a laxative. The EU accepts senna leaf for short-term occasional constipation (well-established use).

Proposed mechanism Authoritative guidance

Senna's sennosides (sennoside A and B) pass through the upper gut unchanged. Gut bacteria in the large bowel turn them into rhein anthrone, which speeds the movement of the bowel and pulls water and salts into it. A bowel movement usually follows after 8 to 12 hours (EU monograph).

A proposed mechanism does not show that the effect happens in people.

Short-term use only. The EU herbal monograph says do not use for more than 1 week; not for children under 12, in pregnancy or breastfeeding, or with bowel blockage, appendicitis, inflammatory bowel disease or unexplained belly pain. Cramps and loose stools are common. See the safety section.

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Constipation in older people in care homes and hospitals

Low certainty

In older people in long-stay care, senna (often combined with fibre) worked at least as well as lactulose in small trials, and a review found no serious side effects. The trials are old and short.

4 studiesSenna with psyllium-type fibre (combination products, amounts per pro…

Studies, doses and limits

What the trials found

Two double-blind trials from 1993 used a senna-plus-fibre product. In 30 long-stay patients aged 65-94 (Kinnunen), senna with a bulk laxative gave 4.5 bowel movements a week vs 1.9-2.2 with lactulose (p < 0.05). In 77 elderly patients in hospitals and nursing homes (Passmore), daily bowel frequency was 0.8 vs 0.6 with lactulose (p <= 0.001); adverse effects did not differ. A 2018 review of 7 trials in long-term care (444 patients) found senna was superior or as effective as the other laxatives it was compared with, with no serious side effects, but the authors said long-term safety and efficacy are not conclusive.

Results

Senna combined with fibre did better than lactulose; both were safe in short trials.

Effect sizes as reported

Bowel movements: 4.5 vs 2.2-1.9 a week (Kinnunen); 0.8 vs 0.6 a day, 95% CI 0.7 to 0.9 vs 0.5 to 0.7 (Passmore).

Why this rating

Two small old trials and a review of 7 short trials of mixed quality. Both main trials used a senna-and-fibre combination, so the benefit cannot be given to senna alone.

Form and dose studied

Senna with psyllium-type fibre (combination products, amounts per product).

Who was studied

People aged 65 and over living in long-stay hospital or nursing-home care.

Limits

1993 trials; combination product; short two-week periods; no long-term data. Older people lose potassium more easily, which the EU monograph highlights.

Why researchers looked

Constipation is very common in long-term care, and the sugar-based laxative lactulose is a common comparison.

Traditional use

The EU monograph covers elderly adults within the adult group for short-term occasional constipation.

Proposed mechanism Authoritative guidance

A proposed mechanism does not show that the effect happens in people.

^{26 47 5 80}

Constipation in children, including after bowel surgery

Very low certainty

Evidence for senna in children is thin. A Cochrane review found almost no senna trials, and two small trials in children with corrected bowel malformations gave opposite answers. The EU monograph says senna leaf must not be given under age 12.

5 studiesDoses used in trials were set by children's doctors (for example up t…

Studies, doses and limits

What the trials found

The 2016 Cochrane review (25 trials, 2,310 children) found only one senna trial, 21 patients against lactulose, with no significant difference. In children with repaired anorectal malformation, one crossover trial against polyethylene glycol was stopped early for a benefit favouring senna (p = 0.026; maximum senna 38.7 mg a day), but a 2025 three-way crossover of 15 patients found no significant difference between sennosides, magnesium hydroxide and PEG (clean fecal loading 40%, 46.7% and 60%; p = 0.655). A 2018 review plus chart review of 640 children found nappy-area blisters in 2.2% (on higher doses) and cramps or diarrhoea in 13%.

Results

Almost no good trials. Two small trials in one special group disagree. Side effects such as nappy-area blistering are documented.

Effect sizes as reported

Cochrane: one senna trial (21 children), no significant difference vs lactulose. ARM 2025 trial: Leech score 6.67 senna vs 5.80 PEG (p = 0.841).

Why this rating

The Cochrane authors rated overall evidence low or very low and found only one senna trial. The two anorectal-malformation trials are tiny and disagree.

Form and dose studied

Doses used in trials were set by children's doctors (for example up to 38.7 mg of sennosides a day in one trial). Do not give to a child without medical advice.

Who was studied

Children with functional constipation, and children with corrected anorectal malformation.

Limits

Tiny trials, one stopped early, one 15-child crossover; no long-term trials; unclear which senna products.

Why researchers looked

Constipation is common in children, and senna is widely prescribed by children's doctors in some countries.

Traditional use

A paediatric review says senna is commonly used by children's doctors, but the EU herbal monograph for senna leaf contraindicates it under 12 years.

Proposed mechanism Authoritative guidance

A proposed mechanism does not show that the effect happens in people.

^{21 57 42 72 80}

Constipation caused by opioid painkillers (cancer care, palliative care, after surgery)

Low certainty

Senna is a standard choice for constipation caused by morphine-type painkillers, but the best head-to-head trials are small. One crossover trial found only weak evidence that polyethylene glycol works better.

8 studiesEscalating doses of sennosides in trials; amounts are set by the care…

Studies, doses and limits

What the trials found

In 70 outpatients with cancer (Hawley 2020), satisfactory bowel movement days were 1.21 times higher on polyethylene glycol than on sennosides (95% credible interval 0.96 to 1.55), which the authors called weak evidence; only 28 completed both periods. A 2024 systematic review of 20 trials (Kistemaker) found no clear differences between laxatives for prevention and one of two treatment trials favoured PEG over sennosides. The 2011 Cochrane review of palliative care (7 trials, 616 people) found laxative comparisons inconclusive. A 2013 review found no randomised trials that met its criteria. In 64 adults after orthopaedic surgery on opioids (Marciniak 2014), senna and lubiprostone both improved symptoms with no significant difference. In 586 matched children and young people with cancer on opioids, starting senna was linked to fewer problems (composite HR 0.70, 95% CI 0.56 to 0.88), but this was a retrospective database study. A volunteer model found senna caused more abdominal pain than lactulose or a combination laxative (P < 0.001).

Results

Senna works in this setting but the evidence is small and does not show it beats other laxatives; PEG may be slightly better.

Effect sizes as reported

PEG 1.21 times more satisfactory days than sennosides (95% credible interval 0.96 to 1.55); composite problem hazard 0.70 (0.56 to 0.88) in children's database study.

Why this rating

Small trials with high drop-out, mixed comparators and conclusions that disagree; the larger paediatric study is observational and based on hospital records.

Form and dose studied

Escalating doses of sennosides in trials; amounts are set by the care team.

Who was studied

Adults with cancer or advanced illness on opioids; adults after orthopaedic surgery; hospitalised children with cancer.

Limits

Small, short trials; comparators differ; no trial shows senna is better than PEG; opioid antagonist drugs were more tested.

Why researchers looked

Opioid painkillers slow the gut and cause constipation in most people who take them. A stimulant laxative like senna is often paired with them.

Traditional use

Senna is widely paired with opioid painkillers in cancer and palliative care (trial and review reports); the EU monograph covers occasional constipation only.

Proposed mechanism Authoritative guidance

A proposed mechanism does not show that the effect happens in people.

^{24 27 54 11 19 34 50 66}

Constipation in people with kidney disease or in intensive care

Very low certainty

A few small trials suggest senna works about as well as lactulose in kidney disease and in intensive care, but there are too few people to be sure.

3 studiesNot clear from the abstracts for the intensive-care trial; combinatio…

Studies, doses and limits

What the trials found

In 22 people with pre-dialysis chronic kidney disease (Nata 2021), senna plus ispaghula husk and lactulose both raised complete spontaneous bowel movements a week (by 2.1 and 1.3) with no significant difference between them (P = 0.276). In 70 intensive-care patients (Alikiaii 2019), a senna product (Senalin) 500 mg a day for 3 days gave fewer bowel movements on day 2 than bisacodyl (P < 0.01) but fewer complications on day 3 (P = 0.04). In 100 people on peritoneal dialysis, sennosides were compared with lactulose for preventing peritonitis (not constipation); lactulose was not better (HR 2.32, 95% CI 0.92 to 5.83).

Results

Senna was comparable to lactulose in kidney disease, and a little slower than bisacodyl in intensive care; all trials were tiny.

Effect sizes as reported

CKD: +2.1 vs +1.3 complete spontaneous bowel movements a week, no significant difference (P = 0.276).

Why this rating

Three small trials with different aims and comparators; one tested peritonitis, not constipation. No placebo comparisons.

Form and dose studied

Not clear from the abstracts for the intensive-care trial; combination product (senna plus husk) in the kidney trial.

Who was studied

Adults with advanced chronic kidney disease, intensive-care patients, and peritoneal dialysis patients.

Limits

Very small samples; two trials had no or retrospective registration; the dialysis trial did not look at constipation.

Why researchers looked

People with advanced kidney disease and people in intensive care often become constipated, and laxatives are needed.

Traditional use

No traditional use specific to these groups.

Proposed mechanism Authoritative guidance

A proposed mechanism does not show that the effect happens in people.

^{41 4 44}

Cleaning the bowel before a colonoscopy (adults)

Mixed findings

Senna, alone or added to a smaller drink of polyethylene glycol (PEG), cleans the bowel about as well as other preparations in many trials and is easier to tolerate, but results are mixed and abdominal pain is common.

9 studiesVarious regimens (high-dose senna alone, or 24 mg with 1 L PEG-ascorb…

Studies, doses and limits

What the trials found

A 2022 meta-analysis of 11 trials (3,343 patients; Tian) found no difference in bowel cleanliness between senna regimens and other preparations (OR 1.02, 95% CI 0.63 to 1.67), better tolerance (OR 1.66) and compliance (OR 3.05) and fewer people with nausea (OR 1.84). Individual trials differ. Senna with lavage left 90% free of solid debris vs 66.7% with lavage alone (Ziegenhagen 1991, 120 people). Split high-dose senna cleaned more than split 4 L PEG: adequate 89.9% vs 73.8% (Coskun 2020, 474), with less vomiting (12.7% vs 29.5%) but more abdominal pain (70.9% vs 43%). Low-volume PEG plus senna matched high-volume PEG (71.9% vs 69.4%; 382 people) and 1 L PEG-ascorbic acid plus senna matched 2 L (88% vs 89%; 344 people). Senna tablets were not equivalent to sodium phosphate (134 people), and adding linaclotide to 1 L PEG-ascorbic acid beat the senna regimen (92% vs 86%; 1,464 people). Senna before 2 L PEG did as well as super-low-volume PEG for cleaning but caused more complications (16.4% vs 1.7%, P = 0.0001; 250 people). A network meta-analysis of 40 trials ranked the senna regimen as the most likely to cause abdominal pain (OR 3.23, 95% credible interval 1.04 to 9.97).

Results

Senna is a reasonable lower-volume option that cleans about as well as the usual preparations in many trials, but it often causes belly pain and some newer combinations clean better.

Effect sizes as reported

Cleanliness OR 1.02 (95% CI 0.63 to 1.67); tolerance OR 1.66 (1.08 to 2.54); compliance OR 3.05 (1.42 to 6.55).

Why this rating

A meta-analysis found no overall difference, but individual trials point both ways depending on the comparison, and the abstract does not give heterogeneity or GRADE. Regimens, senna doses and comparators differ widely.

Form and dose studied

Various regimens (high-dose senna alone, or 24 mg with 1 L PEG-ascorbic acid, or 1 g a day for 3 days before 2 L PEG). Amounts for a bowel preparation are always set by the endoscopy team.

Who was studied

Adult outpatients having colonoscopy.

Limits

Different regimens and endoscopist-blinded designs; several trials are from Japan; many are single-centre; adenoma detection was not clearly improved.

Why researchers looked

The test needs an empty bowel. Standard preparations mean drinking several litres of fluid, which many people dislike, so lower-volume plans with senna have been tested.

Traditional use

Senna tablets and extracts are used for colonoscopy preparation in some countries (trial reports). The EU monograph covers only occasional constipation, not bowel preparation.

Proposed mechanism Authoritative guidance

A proposed mechanism does not show that the effect happens in people.

Abdominal pain was more common with senna regimens in two trials and a network analysis. Short-term use only. The EU herbal monograph says do not use for more than 1 week; not for children under 12, in pregnancy or breastfeeding, or with bowel blockage, appendicitis, inflammatory bowel disease or unexplained belly pain. Cramps and loose stools are common. See the safety section.

^{68 79 16 28 55 32 33 25 65}

Cleaning the bowel before a colonoscopy (children and young people)

Evidence against

In children, a polyethylene glycol (PEG) powder cleaned better than senna in the trials found, so the evidence points against senna as the first choice.

2 studiesTrial senna doses were 15 or 30 mL a day for 2 days (liquid product);…

Studies, doses and limits

What the trials found

In 30 patients aged 6-21 (Terry 2013), excellent or good preparation was 88% with PEG powder vs 29% with senna (P = 0.0022) and the trial was stopped early. A 2021 meta-analysis of 3 trials (318 patients) found PEG better (RR 1.35, 95% CI 1.05 to 1.74) and less painful (RR 0.62, 95% CI 0.44 to 0.87), with no serious adverse events; certainty low to moderate.

Results

PEG was better and less painful than senna.

Effect sizes as reported

PEG vs senna: RR 1.35 (95% CI 1.05 to 1.74) for good preparation; pain RR 0.62 (0.44 to 0.87).

Why this rating

Three trials, 318 children, the authors rate certainty low to moderate, and all pointed in the same direction (PEG better).

Form and dose studied

Trial senna doses were 15 or 30 mL a day for 2 days (liquid product); not for use by families without a children's doctor.

Who was studied

Children and young people aged 6-21.

Limits

Few trials; small; the senna arm needed an extra full-fluid day in one trial.

Why researchers looked

Children also need a clean bowel for colonoscopy, and senna is one of the older options.

Traditional use

No traditional use for this.

Proposed mechanism Authoritative guidance

A proposed mechanism does not show that the effect happens in people.

^{67 75}

Preparing the bowel for capsule endoscopy (swallowed camera)

Mixed findings

Results are mixed: one trial found senna with magnesium citrate did not improve views and was less comfortable, another found senna with fasting improved views of the lower small bowel, and a meta-analysis links adjunct laxatives to better cleaning for colon capsules.

4 studiesRegimens vary; amounts set by the endoscopy team.

Studies, doses and limits

What the trials found

In 150 patients (Postgate 2009), a magnesium citrate plus senna regimen did not improve transit time, completion or view quality and was less convenient and comfortable than a standard preparation. In 180 patients (Chen 2017), three days of fasting plus oral senna 3 g three times a day with mannitol and simethicone gave better cleansing of the whole and distal small bowel than the other two preparations (proximal small bowel did not differ). A 2023 meta-analysis (26 observational studies, 5 randomised trials) linked adjunct laxatives to higher adequate cleansing for colon capsules (OR 1.81, 95% CI 1.13 to 2.90) but with very high heterogeneity. A retrospective study of 242 patients found sennoside A+B similar to PEG for small-bowel capsule preparation.

Results

Mixed. Senna sometimes helps, but it makes the preparation harder.

Effect sizes as reported

Adjunct laxatives OR 1.81 (95% CI 1.13 to 2.90) for colon capsule cleansing (observational, high heterogeneity).

Why this rating

Two small randomised trials disagree; the review and the comparison study are mostly observational.

Form and dose studied

Regimens vary; amounts set by the endoscopy team.

Who was studied

Adults having small-bowel or colon capsule endoscopy.

Limits

Combination regimens with other agents and fasting make senna's own effect unclear.

Why researchers looked

A swallowed camera takes pictures as it travels, and food or bile in the way can hide problems.

Traditional use

No traditional use for this.

Proposed mechanism Authoritative guidance

A proposed mechanism does not show that the effect happens in people.

^{49 13 53 3}

Cleaning the bowel before colon or rectal surgery

Low certainty

One large French trial found senna cleaned the bowel better than polyethylene glycol before colorectal surgery without more infections or leaks, but it is from 1999.

1 studiesOne package of a senna product the evening before surgery; surgical t…

Studies, doses and limits

What the trials found

In 523 patients having elective colon or rectal removal at 18 centres (Valverde 1999), senna the evening before gave better colonic cleanliness than PEG (P = 0.006) and stools in the colon were less fluid (P = 0.001). Postoperative infection (14.7% vs 17.7%) and anastomotic leakage (5.3% vs 5.7%) did not differ significantly. Senna was better tolerated when the bowel was narrowed (P = 0.03).

Results

Better cleaning than PEG with similar infection and leak rates in one large trial.

Effect sizes as reported

Senna vs PEG: infection complications 14.7% vs 17.7%; leakage 5.3% vs 5.7% (not significant).

Why this rating

One large single-design trial from 1999; surgical practice has changed since 1999 and the abstract does not say how the result applies today.

Form and dose studied

One package of a senna product the evening before surgery; surgical teams set the plan.

Who was studied

Adults having elective colon or rectal resection for cancer or diverticular disease.

Limits

One trial, old, single-blind; patients also had enemas and antibiotics.

Why researchers looked

Surgeons have used bowel cleaning before bowel surgery, and the volume of PEG is hard for patients to drink.

Traditional use

No traditional use for this.

Proposed mechanism Authoritative guidance

A proposed mechanism does not show that the effect happens in people.

⁷⁰

Constipation and slow bowel recovery after surgery

Mixed findings

After surgery, senna with other laxatives helped bowel recovery in two trials, but a third trial after shoulder surgery found no benefit. The senna was combined with other laxatives, so senna alone is not proven.

4 studiesDocusate with senna (and macrogol) in trials; amounts set by the surg…

Studies, doses and limits

What the trials found

After colorectal surgery in 170 adults (STIMULAX, 2021), docusate with senna plus macrogol shortened the time to stool and solid food (median 2 vs 3 days, P = 0.029) and lowered prolonged postoperative ileus (22% vs 38%, P = 0.030), without changes in hospital stay or complications. After pelvic reconstructive surgery in 96 women (Patel 2010), senna 8.6 mg with docusate 50 mg brought the first bowel movement 1 day sooner than placebo (3.00 vs 4.05 days, P < .002) and cut magnesium citrate use (7.0% vs 43.6%). After rotator cuff repair in 107 patients (Weekes 2021), senna did not change constipation (66.7% vs 64.3% with nothing). A 30-person pilot in an orthopaedic unit was too small to show a result.

Results

Positive in two trials of multi-drug regimens, null in one trial of senna alone after shoulder surgery.

Effect sizes as reported

Median time to stool and solid food 2 vs 3 days (P = 0.029); first bowel movement 3.00 vs 4.05 days (P < .002); shoulder surgery: no difference.

Why this rating

Two positive trials used combinations with docusate or macrogol; the one trial of senna alone was null. Sizes are 96 to 170.

Form and dose studied

Docusate with senna (and macrogol) in trials; amounts set by the surgical team.

Who was studied

Adults after colorectal, pelvic or shoulder surgery.

Limits

Different surgeries and combinations; one was open label; only the hospital course was followed.

Why researchers looked

Surgery, anaesthesia and opioid painkillers slow the bowel and delay the first bowel movement.

Traditional use

No traditional use for this.

Proposed mechanism Authoritative guidance

A proposed mechanism does not show that the effect happens in people.

Do not use if there is any chance of bowel blockage or ileus unless a doctor advises; the EU monograph lists obstruction, stenosis and atony as contraindications. Short-term use only. The EU herbal monograph says do not use for more than 1 week; not for children under 12, in pregnancy or breastfeeding, or with bowel blockage, appendicitis, inflammatory bowel disease or unexplained belly pain. Cramps and loose stools are common. See the safety section.

^{17 48 76 7}

Constipation after giving birth

Low certainty

Senna may help women have their first bowel movement sooner after delivery, but the evidence is old and low-certainty, and it may cause cramps. The EU monograph advises against senna leaf in breastfeeding.

2 studiesStandardised senna tablets in the old trials; amounts set by the midw…

Studies, doses and limits

What the trials found

The 2020 Cochrane review (5 trials, 1,208 women) found that in one trial of 471 women senna may raise the number of women with a first bowel movement within 24 hours (RR 2.90, 95% CI 2.24 to 3.75; low certainty), may reduce the number whose first movement came on days 2 and 3, and may raise abdominal cramps (RR 4.23, 95% CI 1.75 to 10.19; low certainty). Effects on babies' stools were very uncertain. The authors say there is insufficient evidence for general conclusions. A 1980 trial of standardised senna (Senokot) reported success in 93-96% vs 51-59% with placebo and cramps in about 13% vs 4%.

Results

Faster first bowel movement but more cramps, from old poorly reported trials.

Effect sizes as reported

First bowel movement within 24 h: RR 2.90 (2.24 to 3.75); cramps RR 4.23 (1.75 to 10.19).

Why this rating

Cochrane rated the key results low certainty; four of five trials are over 40 years old and poorly reported.

Form and dose studied

Standardised senna tablets in the old trials; amounts set by the midwife or doctor.

Who was studied

Women in the first days after delivery.

Limits

Old trials; poor reporting; breastfeeding safety disputed (EU monograph contraindicates use in lactation; LactMed says usual doses are acceptable).

Why researchers looked

Constipation is common after delivery, with pain from stitches and haemorrhoids.

Traditional use

Older trial reports exist; the Cochrane review notes that four of its five trials are over 40 years old.

Proposed mechanism Authoritative guidance

A proposed mechanism does not show that the effect happens in people.

Breastfeeding: the EU monograph contraindicates senna leaf; LactMed (abstract) says usual doses are acceptable. Ask a doctor. Short-term use only. The EU herbal monograph says do not use for more than 1 week; not for children under 12, in pregnancy or breastfeeding, or with bowel blockage, appendicitis, inflammatory bowel disease or unexplained belly pain. Cramps and loose stools are common. See the safety section.

^{69 59}

Connections to the rest of health

How Senna connects to the rest of our health knowledge graph. Every link says what kind of connection it is. A safety link (for example to the liver) is a warning, not a benefit. A study that merely mentions a topic never creates a benefit link.

Explore every connection: goals, body systems, organs, symptoms, genes

Kind of connection Connected to Search

A. Wellness goals

Connected to	Kind of connection	Evidence status	Context	Studies
Digestive support	Demonstrated clinical effect	Moderate certainty	Short-term relief of occasional constipation. Chronic constipation in adults: more bowel movements: Senna probably helps adults who have long-standing constipation to go to the toilet more often. In the one placebo-controlled trial, about 7 in 10 people on senna improved, compared with about 1 in 10 on placebo. Preparation or compound: Senna leaf or pods	^{80 40 52 51}
Gut health	Biological association	Low certainty	Colon lining staining (melanosis coli) is a marker of long laxative use and usually resolves after stopping. Preparation or compound: Senna	^{15 14}
Gut Health	Demonstrated clinical effect	Moderate certainty	Chronic constipation in adults: more bowel movements: Senna probably helps adults who have long-standing constipation to go to the toilet more often. In the one placebo-controlled trial, about 7 in 10 people on senna improved, compared with about 1 in 10 on placebo.	^{40 52 51 80}
Digestive Support	Potential benefit	Low certainty	Constipation in older people in care homes and hospitals: In older people in long-stay care, senna (often combined with fibre) worked at least as well as lactulose in small trials, and a review found no serious side effects. The trials are old and short. Constipation in children, including after bowel surgery: Evidence for senna in children is thin. A Cochrane review found almost no senna trials, and two small trials in children with corrected bowel malformations gave opposite answers. The EU monograph says senna leaf must not be given under age 12.	^{26 47 5 80 21 57 42 72 24 27 54 11 19 34 50 66 41 4 44 68 79 16 28 55 32 33 25 65 67 75 49 13 53 3 70 17 48 76 7 69 59}
Gut Health	Potential benefit	Low certainty	Constipation in older people in care homes and hospitals: In older people in long-stay care, senna (often combined with fibre) worked at least as well as lactulose in small trials, and a review found no serious side effects. The trials are old and short. Constipation in children, including after bowel surgery: Evidence for senna in children is thin. A Cochrane review found almost no senna trials, and two small trials in children with corrected bowel malformations gave opposite answers. The EU monograph says senna leaf must not be given under age 12.	^{26 47 5 80 21 57 42 72 24 27 54 11 19 34 50 66 41 4 44 68 79 16 28 55 32 33 25 65 67 75 49 13 53 3 70 17 48 76 7 69 59}

B. Body systems

Connected to	Kind of connection	Evidence status	Context	Studies
Digestive system	Demonstrated clinical effect	Moderate certainty	Stimulant laxative: speeds large-bowel movement and pulls fluid into the bowel after 8 to 12 hours. Preparation or compound: Senna leaf or pods, sennosides	^{80 40}
Cardiovascular system	Drug or supplement interaction	Authoritative guidance	Added potassium loss. Preparation or compound: Senna with diuretics, corticosteroids or licorice	⁸⁰
Reproductive system	Contraindication	Authoritative guidance	Contraindicated in pregnancy by the EU monograph because of genotoxic risk of related anthranoids; the EU has no fertility data. Preparation or compound: Senna leaf	^{80 56}
Skin	Adverse effect or risk	Case series	Nappy-area blistering in children after long stool contact. Preparation or compound: Senna	^{72 46 36}
Immune system	Adverse effect or risk	Authoritative guidance	Itching, hives and rash listed as possible hypersensitivity effects. Preparation or compound: Senna	⁸⁰
Digestive System	Biological association	Moderate certainty	Studied for: Chronic constipation in adults: more bowel movements Studied for: Constipation in older people in care homes and hospitals	^{40 52 51 80 26 47 5 21 57 42 72 24 27 54 11 19 34 50 66 41 4 44 68 79 16 28 55 32 33 25 65 67 75 49 13 53 3 70 17 48 76 7 69 59}

C. Body parts and organs

Connected to	Kind of connection	Evidence status	Context	Studies
Gut	Adverse effect or risk	Authoritative guidance	Cramps, loose stools, melanosis coli; dependence with long use. Preparation or compound: Senna	^{80 14}
Liver	Adverse effect or risk	Case report	Cases of acute and cholestatic hepatitis; LiverTox says injury is possible at high, prolonged doses. Preparation or compound: Senna at high doses for long periods	^{2 71 62 22}
Kidneys	Adverse effect or risk	Animal	Dark kidneys with tubular pigment and changes in rats; albuminuria and haematuria with long use per the EU monograph; kidney damage in a case of very high intake. Preparation or compound: Senna pods, large doses	^{37 80 71}
Heart	Drug or supplement interaction	Authoritative guidance	Potassium loss can strengthen digoxin effects; a case-control study found a 1.61-fold higher chance of digoxin toxicity. Preparation or compound: Senna with digoxin or heart rhythm medicines	^{80 74}

G. Root causes and contributing factors

Connected to	Kind of connection	Evidence status	Context	Studies
Medication side effects	Potential benefit	Low certainty	Used for opioid-induced constipation; evidence low (small trials, possibly slightly less effective than PEG). Preparation or compound: Senna or sennosides	^{24 27}

I. Biomarkers

Connected to	Kind of connection	Evidence status	Context	Studies
Spontaneous bowel movements per week	Biological association	Moderate certainty	Measured in trials: raised. A lab change is not the same as a health benefit.	^{40 26 47 41}
Constipation symptom and quality-of-life scores (PAC-SYM, PAC-QOL)	Biological association	Low certainty	Measured in trials: mixed. A lab change is not the same as a health benefit.	^{40 34}
Need for enema, extra laxatives or an X-ray	Biological association	Low certainty	Measured in trials: lowered. A lab change is not the same as a health benefit.	^{19 34}
Faecal loading on abdominal X-ray (Leech score)	Biological association	Very low certainty	Measured in trials: no-change. A lab change is not the same as a health benefit.	^{42 57}
Bowel cleanliness score (Boston Bowel Preparation Scale and others)	Biological association	Mixed findings	Measured in trials: mixed. A lab change is not the same as a health benefit.	^{68 16 33 32}
Adenoma detection rate	Biological association	Low certainty	Measured in trials: no-change. A lab change is not the same as a health benefit.	²⁵
Time to the first bowel movement or return of gut function	Biological association	Low certainty	Measured in trials: lowered. A lab change is not the same as a health benefit.	^{48 17 69}
Small-bowel cleansing for capsule endoscopy	Biological association	Mixed findings	Measured in trials: mixed. A lab change is not the same as a health benefit.	^{13 49}

J. Genes, receptors and enzymes

Connected to	Kind of connection	Evidence status	Context	Studies
TP53	Preliminary mechanism	Animal	Heterozygous p53 knockout mice were used by the US NTP to test senna for tumours: none at up to 10,000 ppm for 40 weeks. In people, p53 expression in the colon was unchanged after a single sennoside dose.	^{43 83 86}
BCL2	Preliminary mechanism	Human	Higher bcl-2 expression in colon crypts that were shorter or had higher proliferation after sennosides in 32 patients.	⁸⁶

K. Biological pathways

Connected to	Kind of connection	Evidence status	Context	Studies
Aquaporin water channels in the colon	Preliminary mechanism	Animal	Sennosides lowered aquaporin expression in rat colon (laxative action); whole extract raised it in kidney and liver.	¹²
Epithelial sodium and chloride absorption	Preliminary mechanism	Authoritative guidance	Anti-absorptive effect of rheinanthrone (EU monograph).	⁸⁰
Bifidobacterium species that hydrolyse sennosides	Preliminary mechanism	Animal	Four strains made rheinanthrone from sennosides in the lab and one increased gut transit in mice.	³⁵
Peptostreptococcus intermedius enzyme	Preliminary mechanism	In vitro	Enzyme that helps reduce sennosides and sennidins to anthrone forms.	²³
Colonic motility (propulsive long-spike bursts)	Preliminary mechanism	Human	Increased in a small human study with sennosides.	⁶³

L. Active compounds

Connected to	Kind of connection	Evidence status	Context	Studies
Sennoside A	Biological association	Authoritative guidance	The main laxative prodrug. It passes the upper gut unchanged; gut bacteria turn it into rheinanthrone. Preparation or compound: Leaf and pod	^{80 78 84}
Sennoside B	Biological association	Authoritative guidance	Laxative prodrug with the same route as sennoside A. Preparation or compound: Leaf and pod	^{80 78 84}
Sennosides C (CID 46173829) and D (CID 46173830)	Biological association	Authoritative guidance	Further sennosides confirmed in the leaf (Franz review). Preparation or compound: Leaf and pod	^{20 84}
Sennidin A (aglycone of sennosides)	Biological association	Authoritative guidance	Aglycone found in blood in small amounts with rhein (EU monograph). Preparation or compound: Formed in the gut	^{80 84}
Rheinanthrone (rhein anthrone)	Biological association	Authoritative guidance	The active laxative metabolite: speeds colon movement and makes the gut lining leakier to water. Preparation or compound: Formed in the large bowel by bacteria	^{80 35 84}
Rhein	Biological association	Authoritative guidance	Absorbed metabolite; small amounts reach breast milk; mutagenic in some bacterial tests (NTP). Preparation or compound: Formed from rheinanthrone by oxidation	^{80 29 18 83 84}
Aloe-emodin	Biological association	Authoritative guidance	The EU monograph names aloe-emodin and emodin among anthranoids with genotoxic findings in lab tests (not proven in living systems for aloe-emodin). Preparation or compound: Part of the sennoside molecule; free forms in small amounts	^{80 29 84}
Emodin	Biological association	In vitro	Genotoxic in some lab tests; a 1997 review (Brusick and Mengs) says emodin and aloe-emodin were the senna-product components that gave some positive genotoxicity results. Preparation or compound: Named as a component of senna products in a 1997 review	^{8 80 84}
Flavonoid glycosides, naphthalene glycosides (6-hydroxymusicin glucoside, tinnevellin glucoside) and other minor compounds	Biological association	Authoritative guidance	Minor constituents; the naphthalene glycosides can distinguish Alexandrian from Tinnevelly senna (Franz review); PubChem CIDs were not looked up. Preparation or compound: Leaf and pod	^{20 78}

Each connection is stored with the ingredient, the connected record, the kind of connection, the evidence status, the supporting studies, the preparation or compound involved, and a review date (last reviewed October 25, 2026).

Evidence at a glance: what changed in 8 lab markers

Tap a number to show only those markers. Counts are markers, not people.

Other2123

The evidence

The research centre for Senna. Every record here was checked against PubMed or the publisher's page; we never list a study we have not verified.

Evidence by outcome

Chronic constipation in adults: more bowel movements 4 studies · 90 people in trials Moderate certainty Constipation in older people in care homes and hospitals 4 studies · 107 people in trials Low certainty Constipation in children, including after bowel surgery 5 studies · 15 people in trials Very low certainty Constipation caused by opioid painkillers (cancer care, palliative care, after surgery) 8 studies · 720 people in trials Low certainty Constipation in people with kidney disease or in intensive care 3 studies · 192 people in trials Very low certainty Cleaning the bowel before a colonoscopy (adults) 9 studies · 3,168 people in trials Mixed findings Cleaning the bowel before a colonoscopy (children and young people) 2 studies · 30 people in trials Evidence against Preparing the bowel for capsule endoscopy (swallowed camera) 4 studies · 330 people in trials Mixed findings Cleaning the bowel before colon or rectal surgery 1 study · 523 people in trials Low certainty Constipation and slow bowel recovery after surgery 4 studies · 373 people in trials Mixed findings Constipation after giving birth 2 studies Low certainty

Bars show how many studies we found for each outcome, not how well it works. People are added up across trials only (reviews are not added, to avoid double counting).

How we rate evidence

High certainty

Several well-run trials or reviews agree; further research is unlikely to change the picture much.

Moderate certainty

Good trials point the same way, but some doubt remains.

Low certainty

Small, short or inconsistent trials. The finding could change with better research.

Very low certainty

Very little or very weak human data. Treat as a possibility only.

Mixed findings

Trials or reviews disagree with each other.

Not enough evidence

Not enough human research to say either way.

Evidence against

Good research found no benefit, or found harm.

We take the reviewers' own risk-of-bias and GRADE statements where they exist, and otherwise judge from study size, design, consistency, directness and whether a product matches what is sold. Many publications do not make evidence high. Method note: We searched PubMed, read the EU herbal monograph on senna leaf in full, the US National Toxicology Program abstract, the abstracts of the LiverTox and LactMed senna records, and checked plant names in GBIF and the NCBI taxonomy and compounds in PubChem. Only abstracts were read for nearly all studies. Some sources were not verified: the full LiverTox chapter, the FDA, WHO and German Commission E texts, any IARC position, EU food-law limits and the traditional history. Certainty ratings are the compiler's own reading, not formal grades unless a review gave them. No study is cited that we could not verify.

Study library: every study we checked 86

Design Research type Plant part Year from Search

Study	Design	People	Product, dose, length	Result
2006 Senna · PMID 30000408	Authoritative guidance	LactMed chapter on senna	Senna unspecified - - · vs -	Abstract (read): an early uncontrolled report using an old senna product found more diarrhoea in breastfed infants, but several controlled studies of modern senna products found no effect on the infant. Usual doses are acceptable during breastfeeding. Acceptable during breastfeeding (LactMed) Methods, limits and funding Outcomes: Breastfeeding Limitations: Only the abstract read. This differs from the EU monograph, which contraindicates use in breastfeeding. Read: abstract
2012 Senna · PMID 31643257	Authoritative guidance	LiverTox chapter on senna	Senna unspecified - - · vs -	Abstract (read): senna is generally safe and well tolerated, but can cause clinically apparent liver injury when used in high doses for longer than recommended. Liver injury at high doses over long periods Methods, limits and funding Outcomes: Liver injury Limitations: Only the abstract on PubMed was read; the full chapter was blocked by a browser check. Read: abstract
Akın 2024 Sennoside A+B Is as Effective as Polyethylene Glycol in Preparation for Small Intestine Capsule Endoscopy Turk J Gastroenterol · PMID 39128101 · DOI	Observational	242 Patients having small-bowel capsule endoscopy, retrospective	Sennoside A+B calcium 250 mL unspecified 250 mL Pre-procedure · vs PEG 4 L	No significant difference in small-bowel cleaning scores (total 1.62 vs 1.66, p = 0.622) or diagnostic value. No difference Methods, limits and funding Outcomes: Small-bowel cleaning scores; diagnostic value Limitations: Retrospective, single centre, non-randomised. Read: abstract
Alikiaii 2019 Comparing the Efficacy of Two Drugs Senalin and Bisacodyl in Treatment of Constipation in Intensive Care Units' Patients Adv Biomed Res · PMID 30993087 · DOI	Controlled trial	70 Adults in intensive care units with constipation	Senalin (senna product) unspecified 500 mg a day 3 days · vs Bisacodyl 10 mg a day	Bisacodyl gave more bowel movements on day 2 (P < 0.01); stool consistency did not differ. Complications on day 3 were fewer with senalin than bisacodyl (P = 0.04). Bisacodyl more bowel movements on day 2 Methods, limits and funding Outcomes: Defecation frequency, stool consistency, complications Limitations: Single centre, 3 days, product composition not described in the abstract. Read: abstract
Alsalimy 2018 Efficacy and safety of laxatives for chronic constipation in long-term care settings: A systematic review J Clin Pharm Ther · PMID 29885259 · DOI	Systematic review	444 Adults in long-term care with chronic constipation; 7 randomised trials	Senna (with or without fibre) among other laxatives unspecified Varied Short · vs Lactulose, sodium picosulphate, docusate, polyethylene glycol and others	Senna and lactulose were the most studied. Senna was superior or as effective as other laxatives. Adverse reactions were similar between arms and no serious ones were reported. The authors say long-term efficacy and safety are not conclusive. Senna superior or equal to comparators Methods, limits and funding Outcomes: Efficacy and safety of laxatives in long-term care Limitations: Only 7 trials, 444 people, short and some of low quality. Read: abstract
Beuers 1991 Hepatitis after chronic abuse of senna Lancet · PMID 1671276 · DOI	Case report	Patient with hepatitis after chronic senna abuse (letter)	Senna unspecified Not read Chronic	Only the title and citation were available: "Hepatitis after chronic abuse of senna". Not read Methods, limits and funding Outcomes: Liver Limitations: Title only; no abstract in PubMed. Read: title-only
Blot 2021 The Effectiveness of a Senokot Cocktail for Postoperative Constipation Orthop Nurs · PMID 34004615 · DOI	Quasi experimental	30 Patients on an orthopaedic rehabilitation unit without a first postoperative bowel movement	Senokot liquid in a prune and lemon juice mixture unspecified Until first bowel movement · vs Senokot liquid alone	The sample was too small (only 80% had a bowel movement in the window) to show significant differences. No conclusion Methods, limits and funding Outcomes: Time to first bowel movement Limitations: Pilot study of 30; quasi-experimental. Funding and conflicts: No conflicts declared Read: abstract
Brusick 1997 Assessment of the genotoxic risk from laxative senna products Environ Mol Mutagen · PMID 9020301 · DOI	Narrative review	Review of genotoxicity tests of senna products	Senna and constituents unspecified - - · vs -	Most tests were negative; some suggest emodin and aloe-emodin have genotoxic activity. The authors do not think senna laxatives pose a genotoxic risk to humans under prescribed use. No genotoxic risk at prescribed use (authors) Methods, limits and funding Outcomes: Genotoxic risk Limitations: 1997; funding and conflicts not stated in the abstract. Read: abstract
Budzynska 2012 Systematic review of breastfeeding and herbs Breastfeed Med · PMID 22686865 · DOI	Systematic review	Women who breastfeed; 32 human studies of herbs (2 on senna)	Herbs including senna unspecified Varied Varied · vs Varied	Studies were very heterogeneous and of poor methodological quality. Senna was one of the most studied herbs (2 studies). The review concludes more research is needed. No firm conclusion for senna Methods, limits and funding Outcomes: Safety and efficacy of herbs during breastfeeding Limitations: Search ended 2010; abstract gives no senna-specific numbers. Read: abstract
Cameron 1988 Milk transfer of rhein in the rhesus monkey Pharmacology · PMID 3368522 · DOI	Animal research animal	2 Two lactating rhesus monkeys	Sennosides (oral) unspecified 1 mg per kg 48 h sampling	Rhein was detectable in plasma from 2 to 12 h and in milk from 4 to 12 h, far below the dose needed for a laxative effect in the suckling offspring. Low milk transfer Methods, limits and funding Outcomes: Rhein in milk and plasma Limitations: Two animals only; 1988. Read: abstract
Candy 2011 Laxatives or methylnaltrexone for the management of constipation in palliative care patients Cochrane Database Syst Rev · PMID 21249653 · DOI	Meta-analysis	616 Palliative care patients with constipation; 7 trials	Laxatives (lactulose, senna, co-danthramer and others) and methylnaltrexone unspecified Varied Varied · vs Placebo or other laxatives	Evidence comparing the laxatives was inconclusive; the clearer finding was for the drug methylnaltrexone vs placebo. All trials under-reported methods. Laxative comparisons inconclusive Methods, limits and funding Outcomes: Laxation; side effects Limitations: Old review (search to 2010), small trials. Read: abstract
Cao 2018 Aquaporins Alteration Profiles Revealed Different Actions of Senna, Sennosides, and Sennoside A in Diarrhea-Rats Int J Mol Sci · PMID 30336596 · DOI	Animal research animal	Rats with senna-induced diarrhoea	Senna extract, sennosides, sennoside A unspecified · vs Control	Senna extract caused weight loss and raised kidney and liver indexes; sennosides had stronger laxative action with lower aquaporin activity in the colon. The authors advise caution in people with kidney or liver disease. More kidney/liver effect with whole extract Methods, limits and funding Outcomes: Aquaporin gene activity; organ indexes Limitations: Rat study with high-dose diarrhoea model. Read: abstract
Chen 2017 Randomized controlled trial of 3 days fasting and oral senna, combined with mannitol and simethicone, before capsule endoscopy Medicine (Baltimore) · PMID 29069003 · DOI	Controlled trial	180 Patients having small-bowel capsule endoscopy	3 days fasting plus oral senna 3 g three times daily, with mannitol and simethicone unspecified 3 g three times daily 3 days · vs Mannitol plus saline (with or without simethicone)	Cleansing of the whole and distal small bowel was significantly better in the senna group; the proximal small bowel did not differ. Better distal small-bowel cleansing Methods, limits and funding Outcomes: Small-bowel cleanliness Limitations: Senna was combined with 3 days of fasting, so effects cannot be separated. Funding and conflicts: No conflicts declared Read: abstract
Chen 2022 Melanosis Coli Is Not Associated with Colonic Dysmotility Nor Severity of Pediatric Functional Constipation Dig Dis Sci · PMID 34379221 · DOI	Cohort study	150 Children (median age 9.9) with functional constipation having colonic manometry and biopsy, 17 with melanosis coli	Sennosides unspecified · vs Those without senna	Sennoside use was linked to melanosis coli (adjusted OR 13.88, 95% CI 4.05 to 47.57). Melanosis coli did not relate to colonic motility or need for surgery. OR 13.88 for melanosis coli (4.05 to 47.57) Methods, limits and funding Outcomes: Melanosis coli and colonic motility Limitations: Single centre, 17 children with melanosis. Read: abstract
Chiba 2024 Colonoscopic Resolution of Melanosis Coli After Cessation of Senna Laxative Use Int Med Case Rep J · PMID 39282237 · DOI	Case report	1 81-year-old woman who took senna for 5 years	Senna unspecified 5 years	Melanosis coli had disappeared 7 months after stopping senna. Resolved in 7 months Methods, limits and funding Outcomes: Melanosis coli on colonoscopy Limitations: One case. Funding and conflicts: No conflicts declared Read: abstract
Coskun 2020 Polyethylene glycol versus split high-dose senna for bowel preparation: A comparative prospective randomized study J Gastroenterol Hepatol · PMID 32424868 · DOI	Controlled trial	474 Outpatients having colonoscopy	Split-dose high-dose senna (1000 mg) unspecified 1000 mg sennoside solution, split Pre-colonoscopy · vs Split-dose 4 L PEG	Mean BBPS 7.35 vs 6.57; adequate cleansing 89.9% vs 73.8% (P = 0.001). Vomiting 12.7% vs 29.5%, nausea 28.7% vs 43.9%, but abdominal pain 70.9% vs 43% (all P < 0.001). Adequate prep 89.9% senna vs 73.8% PEG Methods, limits and funding Outcomes: Boston Bowel Preparation Scale; side effects Limitations: Single centre; endoscopist blinded only; very high dose. Read: abstract
Dudi-Venkata 2021 Impact of STIMUlant and osmotic LAXatives (STIMULAX trial) on gastrointestinal recovery after colorectal surgery: randomized clinical trial Br J Surg · PMID 34136900 · DOI	Controlled trial	170 Adults having elective colorectal resection or stoma surgery, Adelaide	Docusate with senna plus macrogol (plus an enema for right-sided surgery) unspecified After surgery · vs Standard recovery care	Median GI-2 2 days vs 3 days (P = 0.029); prolonged postoperative ileus 22% vs 38% (P = 0.030). No difference in hospital stay or complications (including anastomotic leak). GI-2 1 day shorter (-1 to 0 days) Methods, limits and funding Outcomes: GI-2 (time to stool and tolerating solids) Limitations: Open-label; the regimen was a multi-drug combination, so senna alone is not tested. Registration: ACTRN12618001261202 Read: abstract
Faber 1988 Relevance of rhein excretion into breast milk Pharmacology · PMID 3368521 · DOI	Human pk	20 20 postpartum women, 100 breast milk samples	Standardised senna laxative with psyllium seed (Agiolax) unspecified 5 g a day containing 15 mg sennosides 3 days	Milk rhein ranged 0 to 27 ng/ml, below 10 ng/ml in 94% of samples. About 0.007% of the sennoside intake (as rhein) reached milk. None of the breast-fed infants had abnormal stool consistency. 0.007% of dose in milk Methods, limits and funding Outcomes: Rhein in breast milk; infant stool Limitations: Small; brand product; short course; funding not stated in the abstract. Read: abstract
Feudtner 2014 Comparative effectiveness of senna to prevent problematic constipation in pediatric oncology patients receiving opioids: a multicenter study of clinically detailed administrative data J Pain Symptom Manage · PMID 24321507 · DOI	Cohort study	586 Hospitalised children and young people with cancer starting 7 or more days of opioids, 78 hospitals (matched sample)	Senna started within 2 days of opioids unspecified Not given 5-day follow-up · vs Other oral bowel medicines	Starting senna was linked to a lower hazard of a composite of problematic constipation (HR 0.70, 95% CI 0.56 to 0.88), of enema (HR 0.31, 0.11 to 0.91) and of abdominal X-ray (HR 0.74, 0.55 to 0.98). Composite HR 0.70 (0.56 to 0.88) Methods, limits and funding Outcomes: Enema, escalation of bowel medicines, abdominal X-ray Limitations: Retrospective administrative data; propensity matching cannot remove all bias; surrogate outcomes. Read: abstract
Franz 1993 The senna drug and its chemistry Pharmacology · PMID 8234429 · DOI	Narrative review	Review of the senna drug and its chemistry	Senna leaflets and pods unspecified - - · vs -	Describes Alexandrian senna (Cassia senna) and Tinnevelly senna (Cassia angustifolia), sennosides A to D (dimers of rhein and aloe-emodin), and says pods have the same constituents in larger amounts. Abstract truncated. - Methods, limits and funding Outcomes: Chemistry Limitations: Abstract truncated at 250 words. Read: abstract
Gordon 2016 Osmotic and stimulant laxatives for the management of childhood constipation Cochrane Database Syst Rev · PMID 27531591 · DOI	Meta-analysis	2310 Children aged 0-18 with functional constipation; 25 randomised trials	Osmotic and stimulant laxatives (senna in one small trial) unspecified Varied Short · vs Placebo or other laxatives	Most comparisons were polyethylene glycol (PEG) vs others. For senna only one trial of 21 patients versus lactulose was found and showed no significant difference in stools per week (P > 0.05). GRADE certainty for the main outcome was low or very low; 14 of 25 trials had high risk of bias. Senna vs lactulose: no significant difference (1 study, 21 patients) Methods, limits and funding Outcomes: Stools per week; adverse events Limitations: Very little senna data; evidence low or very low certainty for the overall review. Read: abstract
Haoudar 2021 Acute Hepatitis and Pancytopenia in a Child With Chronic Abuse of Senna Cureus · PMID 33552756 · DOI	Case report	1 3-year-old girl with chronic constipation given senna drinks	Senna drinkable preparations unspecified Chronic	Severe acute hepatitis with pancytopenia and deep vein thrombosis, probably related to toxic effects of senna; malignancy and severe infection were excluded. Probable senna toxicity in one child Methods, limits and funding Outcomes: Liver, bone marrow Limitations: One case; abstract does not describe the exact product or dose. Funding and conflicts: No competing interests declared Read: abstract
Hattori 1988 Metabolism of sennosides by human intestinal bacteria Pharmacology · PMID 3368516 · DOI	Laboratory research in-vitro	Human intestinal bacteria	Sennosides unspecified - Lab · vs -	An enzyme from the gut bacterium Peptostreptococcus intermedius helps reduce sennosides and sennidins to 8-glucosyl-rhein anthrone and rhein anthrone. Bacteria produce the active form Methods, limits and funding Outcomes: Metabolism Limitations: 1988 lab work. Read: abstract
Hawley 2020 PEG vs. sennosides for opioid-induced constipation in cancer care Support Care Cancer · PMID 31321524 · DOI	Controlled trial	70 Outpatients with cancer, at risk of or having opioid-induced constipation	Sennosides (escalating bowel protocol) unspecified Escalating doses Two 21-day periods, crossover · vs Polyethylene glycol (double-dummy)	Only 42 finished the first period and 28 both. Satisfactory bowel movement days were 1.21 times higher on PEG than on sennosides (95% credible interval 0.96 to 1.55). No difference in patient preference. The authors call the evidence that PEG is better weak. PEG 1.21 times more satisfactory days (0.96 to 1.55) Methods, limits and funding Outcomes: Days with a satisfactory bowel movement; time to goal; preference Limitations: Many dropouts; small. Read: abstract
Ishibashi 2022 Pre-administration of super-low volume polyethylene glycol is as effective as senna laxative as bowel preparation for colonoscopy: a randomized controlled phase 2 trial Surg Endosc · PMID 34159460 · DOI	Controlled trial	250 Adults having colonoscopy in Japan (122 per group analysed)	Senna 1 g a day for 3 days plus 2 L PEG on the day unspecified 1 g a day 3 days · vs Super-low volume PEG (13.9 g) for 3 days plus 2 L PEG	Responder rates 56.6% vs 50.8%; adenoma detection 34.9% vs 41.8% (P = 0.3795). Complications were 16.4% with senna vs 1.7% with PEG (P = 0.0001) and adherence 82.8% vs 93.4% (P = 0.0101). Complications 16.4% senna vs 1.7% Methods, limits and funding Outcomes: Boston scale responder rate; adenoma detection; complications Limitations: Phase 2 trial; investigator-blinded. Read: abstract
Kinnunen 1993 Safety and efficacy of a bulk laxative containing senna versus lactulose in the treatment of chronic constipation in geriatric patients Pharmacology · PMID 8234438 · DOI	Controlled trial	30 Geriatric long-stay patients aged 65-94 (mean 81.8) with chronic constipation, Finland	Bulk laxative plus senna (Agiolax) unspecified 14.8 g a day · vs Lactulose (20.1 g a day)	Bulk laxative plus senna gave more frequent bowel habits than lactulose (4.5 vs 2.2-1.9 a week, p < 0.05). Both were safe to use. 4.5 vs 2.2-1.9 bowel movements a week Methods, limits and funding Outcomes: Bowel frequency per week Limitations: Very small; the senna product also contains bulk-forming seed husk, so the effect cannot be put down to senna alone; 1993 report. Read: abstract
Kistemaker 2024 Pharmacological prevention and treatment of opioid-induced constipation in cancer patients: A systematic review and meta-analysis Cancer Treat Rev · PMID 38452708 · DOI	Meta-analysis	Cancer patients with opioid-induced constipation; 20 trials (prevention and treatment)	Laxatives including sennosides, and newer drugs unspecified Varied Varied · vs Other laxatives, placebo, opioid antagonists	For prevention, three trials comparing laxatives found no clear differences. For treatment, one of two laxative trials found PEG significantly more effective than sennosides. The meta-analysis could pool only the newer opioid-antagonist drugs, not senna. One trial: PEG better than sennosides Methods, limits and funding Outcomes: Bowel function; adverse events Limitations: No pooled result for senna was possible. Read: abstract
Kositchaiwat 2006 Comparative study of two bowel preparation regimens for colonoscopy: senna tablets vs sodium phosphate solution World J Gastroenterol · PMID 17006995 · DOI	Controlled trial	134 Adults needing elective colonoscopy	Senna tablets unspecified 180 mg Day before · vs Sodium phosphate solution 95 mL	Senna was not equivalent to sodium phosphate (95% CIs outside the equivalence range); taste was better and side effects fewer with senna. The authors say senna may be an alternative. Not equivalent; sodium phosphate cleaner Methods, limits and funding Outcomes: Colon cleanliness score Limitations: Sodium phosphate is rarely used now. Read: abstract
Krumbiegel 1993 Rhein and aloe-emodin kinetics from senna laxatives in man Pharmacology · PMID 8234418 · DOI	Human pk	10 10 healthy volunteers	Agiolax and Sennatin senna laxatives unspecified Therapeutic doses, repeated 96 h blood sampling · vs Crossover of two products	Aloe-emodin was not detectable. Rhein peaked at 150-160 ng/ml, with peaks at 3-5 h and 10-11 h after dosing. Rhein up to 160 ng/ml Methods, limits and funding Outcomes: Plasma rhein and aloe-emodin Limitations: Small; 1993. Read: abstract
Le 2021 Pharmacology, Toxicology, and Metabolism of Sennoside A, A Medicinal Plant-Derived Natural Compound Front Pharmacol · PMID 34764866 · DOI	Narrative review	Review of sennoside A pharmacology and toxicology	Sennoside A unspecified - - · vs -	Lists lab effects (laxative, anti-inflammatory and others) and notes that long-term, large doses may cause melanosis coli and possibly colon cancer; it is not established whether sennoside A or its metabolites are responsible. Mostly lab-based Methods, limits and funding Outcomes: Pharmacology and toxicity Limitations: Narrative review; mostly animal and cell work. Read: abstract
Lombardi 2022 Anthraquinone laxatives use and colorectal cancer: A systematic review and meta-analysis of observational studies Phytother Res · PMID 35040201 · DOI	Meta-analysis	8 observational studies on anthraquinone laxatives and colorectal cancer; 5 pooled	Anthraquinone laxatives (including senna) unspecified Varied Varied · vs Other or no laxatives	Use of anthraquinone laxatives was associated with colorectal cancer at OR 1.41 (95% CI 0.94 to 2.11), not statistically significant. The authors say no link can be shown, but the trend calls for more high-quality studies. OR 1.41 (0.94 to 2.11) Methods, limits and funding Outcomes: Colorectal cancer (CRC) Limitations: Observational data, evidence moderate to low quality; covers all anthraquinone laxatives. Funding and conflicts: No conflict declared Read: abstract
Maeda 2023 Efficacy and tolerability of 1 L polyethylene glycol plus ascorbic acid with senna versus 2 L polyethylene glycol plus ascorbic acid for colonoscopic bowel preparation: Prospective, randomized, investigator-blinded trial Dig Endosc · PMID 36567637 · DOI	Controlled trial	344 Outpatients having colonoscopy (Japan)	1 L PEG with ascorbic acid plus senna unspecified 24 mg senna with 1 L PEG-Asc Pre-colonoscopy · vs 2 L PEG with ascorbic acid	Adequate preparation 88% vs 89% (P = 1.00), non-inferior. Willingness to repeat 85% vs 62% (P < 0.01). 88% vs 89% adequate Methods, limits and funding Outcomes: Boston Bowel Preparation Scale; tolerability Limitations: Single centre; investigator-blinded. Registration: jRCT1051220043 Read: abstract
Maeda 2025 Efficacy of 1 L Polyethylene Glycol Plus Ascorbic Acid With Linaclotide Versus Senna for Bowel Preparation: A Multicenter, Endoscopist-Blinded, Randomized Controlled Trial (Apple Trial) Am J Gastroenterol · PMID 39996602 · DOI	Controlled trial	1464 Outpatients having colonoscopy at 5 Japanese centres	1 L PEG with ascorbic acid plus senna (control arm) vs plus linaclotide unspecified 24 mg senna with 1 L PEG-Asc Pre-colonoscopy · vs 1 L PEG-Asc plus linaclotide 0.5 mg	Senna arm had lower adequate preparation than linaclotide arm: 86% vs 92% (P = 0.001); in high-risk patients 86% vs 94%; in low-risk patients both 94%. Adverse events and willingness to repeat were similar. 86% senna arm vs 92% linaclotide arm Methods, limits and funding Outcomes: Adequate preparation (Boston scale) Limitations: Senna was the comparator here, not the tested drug. Funding and conflicts: No competing interests declared Read: abstract
Marciniak 2014 Lubiprostone vs Senna in postoperative orthopedic surgery patients with opioid-induced constipation: a double-blind, active-comparator trial World J Gastroenterol · PMID 25473191 · DOI	Controlled trial	64 Adults needing opioids after orthopaedic surgery in inpatient rehabilitation (mean age 71.5)	Senna (generic, 2 capsules daily) unspecified 2 capsules a day 6 days · vs Lubiprostone twice daily	Both treatments improved constipation symptoms and quality of life with no significant difference between them (PAC-SYM change -0.36 senna vs -0.20 lubiprostone, P = 0.61). Senna group had a larger reduction in abdominal pain (P = 0.04). 75% in each group needed rescue treatment. No difference between senna and lubiprostone Methods, limits and funding Outcomes: Patient assessment of constipation symptoms and quality of life Limitations: No placebo group; 56 analysed; 15 dropped out; funding not stated in the abstract. Read: abstract
Matsumoto 2012 Promotion of intestinal peristalsis by Bifidobacterium spp. capable of hydrolysing sennosides in mice PLoS One · PMID 22384059 · DOI	Animal research animal	Mice; 135 bacterial strains tested	Sennosides with Bifidobacterium strains unspecified · vs Control	Four Bifidobacterium strains broke down more than 70% of sennoside and produced rheinanthrone; one strain increased gut transit in mice. Bacteria activate sennosides Methods, limits and funding Outcomes: Sennoside hydrolysis; peristalsis Limitations: Mouse study; authors are employees of a dairy company with a patent application. Funding and conflicts: Industry-linked (dairy company employees, patent filed) Read: abstract
Melvin 2019 Laxative-Induced Contact Dermatitis Pediatr Emerg Care · PMID 29746360 · DOI	Case report	1 5-year-old girl with constipation given Ex-Lax	Senna (Ex-Lax) unspecified	Blistering buttock rash from irritant dermatitis after a bowel movement, first thought to be a burn. Erosive diaper dermatitis Methods, limits and funding Outcomes: Skin Limitations: One case. Read: abstract
Mitchell 2006 An oral carcinogenicity and toxicity study of senna (Tinnevelly senna fruits) in the rat Arch Toxicol · PMID 16205914 · DOI	Animal research animal	Sprague-Dawley rats, 60 per sex per group	Senna (Tinnevelly senna fruits) by gavage pod (fruit) 0, 25, 100 or 300 mg per kg a day Up to 104 weeks · vs Vehicle	No treatment-related tumours. All treated groups had kidney pigment and tubular changes and mild colon/caecum hyperplasia, reversible in an earlier 13-week study. Mucoid faeces and electrolyte changes at 300 mg/kg a day. No carcinogenicity at up to 300 mg/kg a day Methods, limits and funding Outcomes: Tumours; kidney and gut changes Limitations: Rat study of senna pods, not leaf; funding not stated in the abstract. Read: abstract
Mizuhara 2005 The influence of the sennosides on absorption of glycyrrhetic acid in rats Biol Pharm Bull · PMID 16204942 · DOI	Animal research animal	Rats	Sennoside A given with glycyrrhizin (licorice compound) unspecified · vs Glycyrrhizin alone	Sennoside A lowered the plasma levels (AUC and Cmax) of glycyrrhetic acid in rats; rhein, sennoside A and sennidin A reduced absorption in a colon loop. Lowered licorice-compound absorption in rats Methods, limits and funding Outcomes: Absorption of glycyrrhetic acid Limitations: Rat study; the interaction in the EU text is about potassium, not absorption. Read: abstract
Morales 2009 Is senna laxative use associated to cathartic colon, genotoxicity, or carcinogenicity? J Toxicol · PMID 20107583 · DOI	Narrative review	Review of senna toxicity, genotoxicity and carcinogenicity literature	Senna extracts and sennosides unspecified - - · vs -	The review found no convincing evidence that chronic senna causes structural nerve or muscle damage; no link between long-term senna extract and tumours in rats (no cancer after 2 years at up to 300 mg/kg a day); and no genotoxic risk shown for senna extracts or sennosides. Sennosides were weakly genotoxic where significant. No carcinogenicity signal in rats Methods, limits and funding Outcomes: Cathartic colon, genotoxicity, carcinogenicity Limitations: Narrative review; included only a selection of literature. Read: abstract
Morishita 2021 Senna Versus Magnesium Oxide for the Treatment of Chronic Constipation: A Randomized, Placebo-Controlled Trial Am J Gastroenterol · PMID 32969946 · DOI	Controlled trial	90 Adults with chronic idiopathic constipation in Japan (mean age 42, 93% women)	Senna (sennoside-containing senna product) unspecified 1.0 g a day 28 days · vs Magnesium oxide 1.5 g a day, or placebo	Overall improvement in 11.7% on placebo, 69.2% on senna and 68.3% on magnesium oxide (P < 0.0001). Bowel movements and quality of life improved more on senna and magnesium oxide than on placebo. No severe treatment-related adverse events. Response 69.2% senna vs 11.7% placebo Methods, limits and funding Outcomes: Overall symptom improvement; spontaneous bowel movements; constipation quality of life Limitations: One centre, 90 people, 4 weeks, mostly women. Abstract does not give which senna product or the plant part. Read: abstract
Nata 2021 Efficacy of Lactulose versus Senna Plus Ispaghula Husk Among Patients with Pre-Dialysis Chronic Kidney Disease and Constipation: A Randomized Controlled Trial Int J Nephrol Renovasc Dis · PMID 34393499 · DOI	Controlled trial	22 People with pre-dialysis chronic kidney disease and constipation (Rome IV)	Senna plus ispaghula husk unspecified 14 days per period, crossover · vs Lactulose	Weekly complete spontaneous bowel movements rose by 2.1 (senna plus husk) and 1.3 (lactulose) from baseline, both p < 0.001; no significant difference between them (P = 0.276). No serious adverse events. No difference between senna plus husk and lactulose Methods, limits and funding Outcomes: Complete spontaneous bowel movements a week; stool form Limitations: Only 22 people; combination product with ispaghula husk; retrospectively registered. Read: abstract
Nate-Anong 2025 Sennosides vs magnesium hydroxide vs polyethylene glycol as a treatment for constipation in anorectal malformation: a randomized crossover trial Pediatr Surg Int · PMID 40856829 · DOI	Controlled trial	15 Patients with surgically corrected anorectal malformation and constipation	Sennosides unspecified 21-day periods, three-way crossover · vs Magnesium hydroxide and polyethylene glycol	Mean Leech scores 6.67 (sennosides), 6.80 (magnesium hydroxide), 5.80 (PEG), p = 0.841. Clean faecal loading in 40%, 46.7% and 60% (p = 0.655). Preference scores favoured sennosides but not significantly (p = 0.582). No significant difference between the three Methods, limits and funding Outcomes: Faecal loading on abdominal X-ray (Leech score); user preference Limitations: Only 15 patients. Read: abstract
National Toxicology Program 2012 Toxicology study of senna (CAS No. 8013-11-4) in C57BL/6NTAC Mice and toxicology and carcinogenesis study of senna in genetically modified C3B6.129F1/Tac-Trp53tm1Brd haploinsufficient mice (Feed Studies) Natl Toxicol Program Genet Modif Model Rep · PMID 23001288	Animal research animal	C57BL/6NTac mice (5 weeks) and p53 haploinsufficient mice (40 weeks)	Senna (CAS 8013-11-4) in feed unspecified Up to 10,000 ppm 5 or 40 weeks · vs Control feed	NTP abstract (read): no evidence of carcinogenic activity in p53 mice at 100 to 10,000 ppm for 40 weeks; epithelial hyperplasia of the colon and caecum in both sexes. Not mutagenic: sennosides A and B; two of four senna samples and rhein were mutagenic in some Salmonella strains. No carcinogenic activity in p53 mouse model Methods, limits and funding Outcomes: Tumours; colon and caecum changes Limitations: 40-week model of limited sensitivity; the PubMed abstract is truncated, results read on the NTP site. Read: summary-only
Noppakun 2021 Comparative effectiveness of lactulose and sennosides for the prevention of peritoneal dialysis-related peritonitis: an open-label, randomized, active-controlled trial Ann Med · PMID 33596746 · DOI	Controlled trial	100 Adults on peritoneal dialysis, Thailand	Sennosides, 2 tablets daily unspecified 2 tablets daily Time to first peritonitis · vs Lactulose 15 mL daily	Lactulose was not better than sennosides; peritonitis HR 2.32 (95% CI 0.92 to 5.83) for lactulose; diarrhoea 38% on lactulose vs 18% on sennosides. HR 2.32 for lactulose (0.92 to 5.83) Methods, limits and funding Outcomes: Time to first bacterial peritonitis Limitations: Open label; not a test of senna against no treatment; peritonitis is the outcome, not constipation. Funding and conflicts: No conflicts reported Registration: TCTR20171012001 Read: abstract
Nusko 2000 Anthranoid laxative use is not a risk factor for colorectal neoplasia: results of a prospective case control study Gut · PMID 10764708 · DOI	Case control	554 202 colorectal cancer, 114 adenoma and 238 control patients, Germany	Anthranoid laxatives unspecified - - · vs No neoplasm controls	No increased risk: odds ratio 1.0 (95% CI 0.5 to 1.9) for adenomas and 1.0 (0.6 to 1.8) for carcinomas; melanosis coli was not a risk factor. OR 1.0 (0.6 to 1.8) Methods, limits and funding Outcomes: Risk of adenoma or carcinoma Limitations: Self-reported laxative use; one centre. Read: abstract
Olorunsogo 2025 Laxative-induced contact burns from accidental ingestion of senna in a 2-year-old female JPGN Rep · PMID 41245024 · DOI	Case report	1 Healthy 2-year-old girl (about 12.5 kg) who accidentally ate one 15 mg sennoside chew	Sennosides unspecified 15 mg (1.2 mg per kg), single accidental dose Single dose	Sharply bordered redness, pain and blisters in the nappy area that healed after treatment; the report says it can mimic abuse injuries. Nappy-area blistering Methods, limits and funding Outcomes: Skin Limitations: One case. Funding and conflicts: Authors report no relevant conflicts Read: abstract
Passmore 1993 Chronic constipation in long stay elderly patients: a comparison of lactulose and a senna-fibre combination BMJ · PMID 8219947 · DOI	Controlled trial	77 Long-stay elderly patients with chronic constipation in hospitals and nursing homes (UK)	Senna-fibre combination unspecified 10 ml daily Two 14-day crossover periods · vs Lactulose 15 ml twice daily	Daily bowel frequency 0.8 (95% CI 0.7 to 0.9) with senna-fibre vs 0.6 (0.5 to 0.7) with lactulose (p <= 0.001). Stool consistency and ease of evacuation scores were higher with senna-fibre. Adverse effects did not differ. 0.8 vs 0.6 bowel movements a day Methods, limits and funding Outcomes: Stool frequency, consistency, ease of evacuation, dose, cost, adverse effects Limitations: Combination product (senna plus fibre); short; 1993; cost figures are UK prices of that time. Read: abstract
Patel 2010 The use of senna with docusate for postoperative constipation after pelvic reconstructive surgery: a randomized, double-blind, placebo-controlled trial Am J Obstet Gynecol · PMID 20207340 · DOI	Controlled trial	96 Women having pelvic reconstructive surgery	Senna 8.6 mg with docusate 50 mg unspecified 8.6 mg senna with 50 mg docusate After surgery · vs Placebo	First bowel movement at 3.00 vs 4.05 days (P < .002). Magnesium citrate rescue needed by 43.6% on placebo vs 7.0% (P<.001). 1 day sooner Methods, limits and funding Outcomes: Time to first bowel movement; magnesium citrate use Limitations: Combination with docusate; abstract does not name industry funding. Read: abstract
Postgate 2009 Are bowel purgatives and prokinetics useful for small-bowel capsule endoscopy? A prospective randomized controlled study Gastrointest Endosc · PMID 19152909 · DOI	Controlled trial	150 Patients having small-bowel capsule endoscopy	Citramag plus senna the evening before unspecified Evening before · vs Standard preparation (fluids, simethicone)	No difference in transit times, completion rates or view quality. The purgative regimens were less convenient and less comfortable. No benefit; less comfort Methods, limits and funding Outcomes: Transit times; completion; view quality Limitations: Magnesium citrate was given with senna so the effect is of the combination. Read: abstract
Ramesh 1998 Managing morphine-induced constipation: a controlled comparison of an Ayurvedic formulation and senna J Pain Symptom Manage · PMID 9803051 · DOI	Non randomised trial	Patients with advanced cancer and morphine-induced constipation, Kerala, India	Senna tablet (Sofsena) unspecified · vs Ayurvedic liquid Misrakasneham	No significant difference in laxative action between the two. The authors favour the Ayurvedic liquid on practical grounds (small volume, taste, cost). No significant difference Methods, limits and funding Outcomes: Laxative action Limitations: Abstract does not give numbers or randomisation; 1998. Read: abstract
Ramkumar 2005 Efficacy and safety of traditional medical therapies for chronic constipation: systematic review Am J Gastroenterol · PMID 15784043 · DOI	Systematic review	Adults with chronic constipation; randomised trials 1966-2003	Traditional medical therapies including senna unspecified Varied Varied · vs Placebo or other treatments	Good evidence for polyethylene glycol and tegaserod, moderate for psyllium and lactulose. The authors found a paucity of quality trials for senna, milk of magnesia, bisacodyl and stool softeners. Senna: too few quality trials to grade (as of 2003) Methods, limits and funding Outcomes: Evidence grading for constipation treatments Limitations: Searched literature only up to 2003; later trials (for example 2021) are not included. Read: abstract
Rao 2021 Efficacy and Safety of Over-the-Counter Therapies for Chronic Constipation: An Updated Systematic Review Am J Gastroenterol · PMID 33767108 · DOI	Systematic review	Adults with chronic constipation; 41 randomised trials of at least 4 weeks (2004-2020)	Over-the-counter treatments including senna unspecified Varied At least 4 weeks · vs Placebo or other treatments	Review graded good evidence (grade A) for polyethylene glycol and for senna, and moderate evidence for psyllium, magnesium salts, other stimulants and some fruits. Diarrhoea, nausea, bloating and abdominal pain were common; no serious adverse events were reported. Grade A recommendation for senna Methods, limits and funding Outcomes: Trial-based grading of over-the-counter constipation treatments Limitations: Authors list small samples, differing designs and outcome measures. Review was funded by a laxative manufacturer (Bayer) and both authors report ties to it. Funding and conflicts: Funding from Bayer US LLC; both authors report consulting ties to Bayer (industry-linked) Read: abstract
Rosa 2023 What Is the Optimal Bowel Preparation for Capsule Colonoscopy and Pan-intestinal Capsule Endoscopy? A Systematic Review and Meta-Analysis Dig Dis Sci · PMID 37833441 · DOI	Meta-analysis	4072 People having colon capsule endoscopy; 26 observational studies and 5 randomised trials	Adjunct sennosides among preparation steps unspecified Varied Varied · vs Other preparation steps	Adjunctive laxatives were linked to higher adequate cleansing (OR 1.81, 95% CI 1.13 to 2.90). The authors support adjunct sennosides, though results were very variable. Adjunct laxatives OR 1.81 (1.13 to 2.90) Methods, limits and funding Outcomes: Adequate cleansing rate; completion rate Limitations: Mostly observational studies; high heterogeneity (I2 over 90%). Funding and conflicts: No conflicts declared Read: abstract
Ruston 2013 Efficacy and side-effect profiles of lactulose, docusate sodium, and sennosides compared to PEG in opioid-induced constipation: a systematic review Can Oncol Nurs J · PMID 24428006 · DOI	Systematic review	Adults on opioids; aimed at randomised trials of docusate, sennosides and lactulose vs PEG	Sennosides, docusate, lactulose unspecified - - · vs Polyethylene glycol	No trials met the inclusion criteria, so nothing could be pooled. The authors call for large randomised trials. No eligible trials Methods, limits and funding Outcomes: Efficacy and side effects in opioid-induced constipation Limitations: An empty review: it shows a gap, not a result. Read: abstract
Sadeghi 2022 Low volume polyethylene glycol combined with senna versus high volume polyethylene glycol, which regimen is better for bowel preparation for colonoscopy? A randomized, controlled, and single-blinded trial Health Sci Rep · PMID 36172298 · DOI	Controlled trial	382 Adults having colonoscopy	Low-volume PEG plus senna unspecified Pre-colonoscopy · vs High-volume PEG alone	Adequate preparation in 71.94% (low-volume PEG plus senna) vs 69.36% (high-volume PEG), P = 0.58. Nausea, bloating, headache and sleeplessness were less common with the senna combination. 72% vs 69% Methods, limits and funding Outcomes: Adequate bowel preparation; adverse effects Limitations: Single centre; single-blinded. Funding and conflicts: No conflicts declared Read: abstract
Samavati 2017 Herbal laxatives and antiemetics in pregnancy Reprod Toxicol · PMID 28610933 · DOI	Narrative review	Pregnant women; review of herbal laxatives and antiemetics	Senna seed/pod and other herbs unspecified - - · vs -	The review calls senna a safe laxative in pregnancy ("senna seed"), and notes that rhubarb emodin caused fetal abnormalities in animals. This conflicts with the EU monograph, which contraindicates senna leaf in pregnancy because of genotoxic risk of some anthranoids. Review rates senna safe; EU monograph disagrees Methods, limits and funding Outcomes: Safety of herbal laxatives in pregnancy Limitations: Narrative review; the abstract says "senna seed", not leaf; does not give trial data. Read: abstract
Santos-Jasso 2017 Effectiveness of senna vs polyethylene glycol as laxative therapy in children with constipation related to anorectal malformation J Pediatr Surg · PMID 27836356 · DOI	Controlled trial	Children with repaired anorectal malformation, continence and constipation	Senna (sennosides A and B) unspecified Maximum 38.7 mg a day Crossover with washout · vs Polyethylene glycol (maximum 17 g a day)	Stopped early because interim analysis showed a benefit favouring senna (p = 0.026). No adverse effects were identified. Favoured senna, p = 0.026 Methods, limits and funding Outcomes: Daily bowel movement, soiling and a clear abdominal X-ray Limitations: Small crossover trial stopped early; the number of children is not given in the abstract; a later trial found no significant difference. Read: abstract
Seybold 2004 Senna-induced hepatitis in a poor metabolizer Ann Intern Med · PMID 15492352 · DOI	Case report	Letter: senna-induced hepatitis in a poor metabolizer	Senna unspecified Not read Not read	Only the title and citation were available. Not read Methods, limits and funding Outcomes: Liver Limitations: Title only; no abstract in PubMed. Read: title-only
Shelton 1980 Standardized senna in the management of constipation in the puerperium: A clinical trial S Afr Med J · PMID 6996138	Controlled trial	Women in the days after delivery with constipation	Standardised senna tablets (Senokot) unspecified Immediately postpartum · vs Placebo	Success in 93% (White) and 96% (Coloured) of treated women vs 51% and 59% on placebo; minor cramps in about 13% vs 4% on placebo. The author says no evidence of an effect on breast-fed babies. 93-96% vs 51-59% success Methods, limits and funding Outcomes: Successful treatment of constipation Limitations: 1980 report; the abstract names the product maker (Reckitt and Colman) but does not give numbers of women. Funding and conflicts: Product maker named in the abstract; funding not stated Read: abstract
Shukla 2021 Role of anthraquinones in Cassia occidentalis induced hepato-myo-encephalopathy J Ethnopharmacol · PMID 33011371 · DOI	Systematic review	Review of Cassia (Senna) occidentalis poisoning, mainly children	Senna occidentalis seeds (a different species) seed High amounts - · vs -	Seeds of this different species cause liver, muscle and brain injury (hepato-myo-encephalopathy), mainly in malnourished children; anthraquinones are held responsible. Different species is toxic Methods, limits and funding Outcomes: Toxicity Limitations: About a different plant, not the laxative senna. Read: abstract
Siegers 1993 Anthranoid laxative abuse--a risk for colorectal cancer? Gut · PMID 8174962 · DOI	Case control	Retrospective study of 3049 and prospective study of 1095 patients having endoscopy	Anthranoid laxatives (aloe, cascara, frangula, rheum) unspecified - - · vs -	Pseudomelanosis coli was more frequent in patients with colorectal cancer (18.6% vs 6.9% with normal findings in the prospective study); the authors calculate a relative risk of 3.04 (95% CI 1.18 to 4.90). Senna is not separated in the abstract. RR 3.04 (1.18 to 4.90) Methods, limits and funding Outcomes: Pseudomelanosis coli and colorectal tumours Limitations: 1993; pseudomelanosis is a marker of long use; confounding possible; senna not named. Read: abstract
Sonmez 2005 Subacute cholestatic hepatitis likely related to the use of senna for chronic constipation Acta Gastroenterol Belg · PMID 16268429	Case report	1 77-year-old man with chronic constipation	Senna unspecified Chronic	Subacute cholestatic hepatitis with bridging necrosis on biopsy; the hepatitis B surface antigen was positive (healthy carrier). Liver tests improved slowly after stopping senna. Senna was judged the likely cause. Likely senna-related cholestatic hepatitis Methods, limits and funding Outcomes: Liver Limitations: One case in a hepatitis B carrier. Read: abstract
Staumont 1988 Sennosides and human colonic motility Pharmacology · PMID 3285363 · DOI	Narrative review	Review of sennoside effects on human colonic motility	Sennosides unspecified - - · vs -	Preliminary results with few subjects showed more propulsive colonic activity (migrating long-spike bursts) after sennosides. Increased propulsion Methods, limits and funding Outcomes: Colon motility Limitations: 1988; few subjects. Read: abstract
Subramani 2025 Aflatoxin B(1) in senna pods from field to storage in Tamil Nadu, India Food Addit Contam Part B Surveill · PMID 39318338 · DOI	Laboratory research n/a	229 229 senna pod samples, Tamil Nadu, India	Senna pods (field to storage) pod (fruit) - 3 years · vs -	Aflatoxin B1 was highest at late harvest (mean 52.4 ug per kg; range up to 206); 37 of 48 late-harvest samples exceeded the 2 ug per kg limit; levels rose in storage to a mean of 18.1 ug per kg. 37 of 48 late samples above limit Methods, limits and funding Outcomes: Aflatoxin B1 Limitations: One region; pods, not leaves. Read: abstract
Sun 2023 Cleaning effect and tolerance of 16 bowel preparation regimens on adult patients before colonoscopy: a network meta-analysis Int J Colorectal Dis · PMID 36905434 · DOI	Meta-analysis	13064 Adults having colonoscopy; 40 trials comparing 16 regimens (network meta-analysis)	Bowel preparation regimens including senna unspecified Varied Varied · vs Other regimens	PEG plus ascorbic acid plus simethicone ranked first for cleansing. The senna regimen ranked first for abdominal pain (OR 3.23, 95% credible interval 1.04 to 9.97), meaning it was the most likely to cause it. Senna regimen more abdominal pain Methods, limits and funding Outcomes: Cleansing; tolerance; adverse events Limitations: Indirect comparisons; senna evidence is a small part. Read: abstract
Sykes 1996 A volunteer model for the comparison of laxatives in opioid-related constipation J Pain Symptom Manage · PMID 8935140 · DOI	Controlled trial	Healthy volunteers given loperamide to mimic opioid constipation (10 per laxative)	Senna (stimulant) unspecified Dose adjusted to restore bowel function Increasing loperamide steps · vs Lactulose; codanthrusate combination	All three laxatives maintained normal bowel function. A stimulant plus softener combination worked at the lowest dose with the fewest adverse effects. Senna caused significantly more adverse effects than the other laxatives, mainly abdominal pain (P < 0.001). More abdominal pain with senna (P < 0.001) Methods, limits and funding Outcomes: Laxative dose, stool form, adverse effects Limitations: Healthy volunteers in a loperamide model, not patients on opioids; 1996. Read: abstract
Terry 2013 Polyethylene glycol powder solution versus senna for bowel preparation for colonoscopy in children J Pediatr Gastroenterol Nutr · PMID 22699838 · DOI	Controlled trial	30 Children and young people aged 6-21 having colonoscopy	Senna liquid unspecified 15 mL daily (6-12 y) or 30 mL daily (12-21 y) 2 days · vs Polyethylene glycol powder (1.5 g/kg split over 2 days)	Stopped early for inferiority of senna. Excellent or good prep in 88% (14/16) with PEG vs 29% (4/14) with senna (P = 0.0022). No serious adverse events. 88% vs 29% good prep Methods, limits and funding Outcomes: Aronchick preparation score Limitations: Only 30 children; stopped early. Read: abstract
Tian 2022 The Efficacy of Senna Bowel Preparation for Colonoscopy: A Systematic Review and Meta-analysis Gastroenterol Nurs · PMID 35758925 · DOI	Meta-analysis	3343 Adults having colonoscopy; 11 trials of senna regimens	Senna-based bowel preparation regimens unspecified Varied Pre-colonoscopy · vs Other bowel preparations	No significant difference in cleanliness (OR 1.02, 95% CI 0.63 to 1.67). Better tolerance (OR 1.66, 1.08 to 2.54) and compliance (OR 3.05, 1.42 to 6.55) and more people without nausea (OR 1.84, 1.45 to 2.32) with senna regimens. Cleanliness OR 1.02 (0.63 to 1.67) Methods, limits and funding Outcomes: Bowel cleanliness; compliance; tolerance; adverse events Limitations: Mixed regimens and comparators; abstract does not give heterogeneity. Funding and conflicts: No conflicts declared Read: abstract
Turawa 2020 Interventions for preventing postpartum constipation Cochrane Database Syst Rev · PMID 32761813 · DOI	Systematic review	1208 Postpartum women; 5 trials (3 randomised, 2 quasi-randomised)	Senna among laxatives unspecified Varied Days after delivery · vs Placebo or no treatment	One trial (471 women) found senna may raise the number of women with a first bowel movement within 24 hours (RR 2.90, 95% CI 2.24 to 3.75; low certainty). It may also raise abdominal cramps (RR 4.23, 95% CI 1.75 to 10.19; low certainty). Effects on babies were very uncertain (very low certainty). The authors say there is insufficient evidence for general conclusions. First BM within 24 h RR 2.90 (2.24 to 3.75) Methods, limits and funding Outcomes: First bowel movement; adverse effects Limitations: Four of five trials were over 40 years old and poorly reported. Funding and conflicts: Cochrane Review, no funding conflict stated in abstract Read: abstract
Valverde 1999 Senna vs polyethylene glycol for mechanical preparation the evening before elective colonic or rectal resection: a multicenter controlled trial. French Association for Surgical Research Arch Surg · PMID 10323423 · DOI	Controlled trial	523 Adults having elective colon or rectal resection for carcinoma or sigmoid diverticular disease, 18 French centres	Senna (1 package in a glass of water) evening before surgery unspecified 1 package Evening before surgery · vs PEG 2 packages in 2-3 L water	Colonic cleanliness better with senna (P = 0.006). Wound infection complications 14.7% vs 17.7% and anastomotic leakage 5.3% vs 5.7% (senna vs PEG), no significant difference. Senna was better tolerated when there was stenosis (P = 0.03). Cleanliness better with senna Methods, limits and funding Outcomes: Colonic cleanliness; infection and leak rates Limitations: 1999 trial, older antibiotics and enemas also given. Read: abstract
Vanderperren 2005 Acute liver failure with renal impairment related to the abuse of senna anthraquinone glycosides Ann Pharmacother · PMID 15956233 · DOI	Case report	1 52-year-old woman who drank 1 L a day of tea from a bag with 70 g dried senna fruit for over 3 years	Senna fruits (pods), herbal tea pod (fruit) About 1 L tea a day (70 g dry pods per bag) Over 3 years	Acute liver failure (INR above 7, encephalopathy) and kidney tubular damage, treated in intensive care; she recovered with supportive care. Cadmium was found in the urine, suggesting possible contamination, which could not be checked. Causality "possible". Possible senna-related liver failure Methods, limits and funding Outcomes: Liver and kidney Limitations: One case; very large intake of pods; possible contamination. Read: abstract
Vilanova-Sanchez 2018 Are Senna based laxatives safe when used as long term treatment for constipation in children? J Pediatr Surg · PMID 29429768 · DOI	Systematic review	640 Children given senna long term; literature review plus one centre chart review (640 patients, 2014-2017)	Senna (sennosides) unspecified Centre median 17.5 mg a day; blisters group median 60 mg a day Long-term	The literature reported perineal blisters in 28 patients, 64% after accidental administration and 36% on long-term prescription. In the centre, 17 of 640 (2.2%) developed blisters, on higher doses (median 60 vs 17.5 mg a day, p < 0.001), all linked to long contact of stool with skin at night. Minor effects (cramps, vomiting, diarrhoea) in 83 (13%). No tolerance and no other long-term side effects were found in the literature. Blisters 2.2%; minor side effects 13% Methods, limits and funding Outcomes: Side effects of senna in children Limitations: Retrospective, single centre, no control group; the authors note little literature on long-term safety. Read: abstract
Vitalone 2011 Cassia angustifolia extract is not hepatotoxic in an in vitro and in vivo study Pharmacology · PMID 21997710 · DOI	Animal research animal	Rat liver cells and Wistar rats	Cassia angustifolia leaf extract (60% sennosides) leaf 12 and 58 mg per kg a day 4 or 8 weeks · vs Control	The extract was toxic to rat liver cells only at concentrations far above those reachable in humans and did not change liver tests or tissue in rats. No liver toxicity in rats Methods, limits and funding Outcomes: Liver damage markers Limitations: Animal and cell study; does not rule out rare human reactions. Read: abstract
Wang 2011 Exposure to sennoside-digoxin interaction and risk of digoxin toxicity: a population-based nested case-control study Eur J Heart Fail · PMID 21803754 · DOI	Case control	3026 Heart failure patients on digoxin, Taiwan: 524 hospitalised for digoxin toxicity and 2,502 matched controls	Sennosides taken with digoxin unspecified Average daily dose 24 mg or more in a subgroup 14 days before index date · vs Matched controls	Sennoside use in the previous 14 days was linked with a 1.61-fold higher risk of digoxin toxicity (95% CI 1.15 to 2.25); with 24 mg or more a day the adjusted OR was 1.93 (1.27 to 2.94). OR 1.61 (1.15 to 2.25) Methods, limits and funding Outcomes: Hospitalisation for digoxin toxicity Limitations: Insurance-claims database; cannot show cause. Read: abstract
Watanabe 2021 Polyethylene Glycol Versus Senna for Bowel Preparation for Colonoscopy in Children: Updated Evidence by a Systematic Review and Meta-Analysis Cureus · PMID 34660023 · DOI	Meta-analysis	318 Children having colonoscopy; 3 randomised trials	Senna unspecified Varied Varied · vs Polyethylene glycol	PEG was preferred over senna for preparation (RR 1.35, 95% CI 1.05 to 1.74) and was less painful (RR 0.62, 0.44 to 0.87). No serious adverse events. Certainty low to moderate. PEG better: RR 1.35 (1.05 to 1.74) Methods, limits and funding Outcomes: Preparation quality; pain Limitations: Only 3 trials. Funding and conflicts: No competing interests declared Read: abstract
Weekes 2021 The efficacy of docusate sodium and senna glycoside for the treatment of constipation after rotator cuff repair: A randomized controlled study J Am Assoc Nurse Pract · PMID 33625162 · DOI	Controlled trial	107 Patients after rotator cuff repair	Senna glycoside (and a docusate arm) unspecified Postoperative days 0-10 and 6 weeks · vs No treatment	Constipation 66.7% with senna, 71.4% with docusate and 64.3% with nothing (p = .88); symptom and quality-of-life scores did not differ. No difference Methods, limits and funding Outcomes: Constipation rate; PAC-SYM and PAC-QOL Limitations: Single centre, unblinded. Funding and conflicts: No conflicts declared Read: abstract
Whorwell 2024 Review article: do stimulant laxatives damage the gut? A critical analysis of current knowledge Ther Adv Gastroenterol · PMID 38887508 · DOI	Narrative review	Review of 43 publications on stimulant laxatives (bisacodyl, picosulfate, senna) and gut damage	Stimulant laxatives including senna unspecified - - · vs -	At higher-than-usual doses reversible surface-cell changes occur and are not considered clinically relevant. The authors found no convincing evidence that stimulant laxatives cause colon cancer, and note that many studies did not allow for other factors. No convincing evidence of gut damage Methods, limits and funding Outcomes: Gut structure changes, cancer Limitations: Narrative review; funding and conflicts not shown in the abstract. Read: abstract
Zibaee 2023 Comparative LC-ESIMS-Based Metabolite Profiling of Senna italica with Senna alexandrina and Evaluating Their Hepatotoxicity Metabolites · PMID 37110216 · DOI	Laboratory research in-vitro	Extracts of Senna alexandrina and Senna italica in liver cancer cells (HepG2)	Methanol extracts of leaf and plant unspecified 50 and 100 ug/mL toxic Lab · vs -	Sennoside A was 1.85% and sennoside B 0.41% of S. alexandrina extract; both species were toxic to liver cells at 50 and 100 ug/mL and almost non-toxic at lower amounts. Sennoside A 1.85% in S. alexandrina Methods, limits and funding Outcomes: Chemical profile; liver cell toxicity Limitations: Cell study; extract content from one analysis. Funding and conflicts: No conflicts declared Read: abstract
Ziegenhagen 1991 Addition of senna improves colonoscopy preparation with lavage: a prospective randomized trial Gastrointest Endosc · PMID 1936833 · DOI	Controlled trial	120 Outpatients and inpatients scheduled for colonoscopy	Senna extract (extractum sennae) the day before, then lavage unspecified Day before · vs Placebo solution, then PEG lavage	Colon free of solid debris in 90% with senna plus lavage vs 66.7% with lavage alone (p < 0.01). Less lavage fluid was needed (p < 0.05). Tolerance similar. No severe adverse events. 90% vs 66.7% clean Methods, limits and funding Outcomes: Colon free of solid debris; lavage volume; tolerance Limitations: 1991 trial, two different groups of 60, old lavage products. Read: abstract
s-ema-hmpc-senna-leaf-2018 EMA/HMPC European Union herbal monograph on Senna alexandrina Mill. (Cassia senna L.; Cassia angustifolia Vahl), folium, EMA/HMPC/625849/2015, adopted 25 September 2018 · Source	Authoritative guidance n/a			Methods, limits and funding Read: full-text
s-gbif-senna-alexandrina GBIF Backbone Taxonomy: Senna alexandrina Mill. (usageKey 2958032) · Source	Reference database n/a			Methods, limits and funding Read: full-text
s-ncbi-taxonomy-senna-alexandrina NCBI Taxonomy: Senna alexandrina (taxid 72402) · Source	Reference database n/a			Methods, limits and funding Read: full-text
s-ntp-gmm15-senna NTP Genetically Modified Model Report 15: toxicology and carcinogenesis study of senna in p53 haploinsufficient mice (feed), April 2012 · Source	Authoritative guidance animal			Methods, limits and funding Read: summary-only
s-pubchem-senna-compounds PubChem compound records for sennoside A (CID 73111), sennoside B (91440), sennosides C and D (46173829, 46173830), sennidin A (92826), rhein (10168), rheinanthrone (119396), aloe-emodin (10207), emodin (3220), kaempferol (5280863), isorhamnetin (5281654) · Source	Reference database n/a			Methods, limits and funding Read: full-text
van Gorkom 1999 Review article: anthranoid laxatives and their potential carcinogenic effects Aliment Pharmacol Ther · PMID 10215727 · DOI	Narrative review	Review of anthranoid laxatives and cancer	Anthranoid laxatives unspecified - - · vs -	Aglycones damage bowel lining cells; pseudomelanosis coli has been associated with higher colorectal cancer risk in some studies; lab and animal studies show a possible role in starting and promoting tumours. The authors say short-term use is generally safe but long-term use cannot be recommended. Cannot recommend long-term use Methods, limits and funding Outcomes: Carcinogenic potential Limitations: 1999; includes cascara, aloe and rhubarb as well as senna. Read: abstract
van Gorkom 2000 Influence of a highly purified senna extract on colonic epithelium Digestion · PMID 10705175 · DOI	Controlled trial	32 Outpatients having colonoscopy lavage; biopsied patients with (15) or without (17) sennosides	Highly purified senna extract (sennosides) unspecified Single high dose with lavage Single dose · vs Lavage without senna	Crypts were shorter and cell proliferation higher after sennosides in the whole colon. The authors say this may reflect a mechanism for a suggested cancer-promoting effect of chronic use. No difference in p53. Higher proliferation after one dose Methods, limits and funding Outcomes: Cell proliferation and crypt length in the colon Limitations: 32 people, one high dose, surrogate markers only. Read: abstract

What we do not know yet

What the evidence supports: chronic adult constipation is moderate; older people, opioid-induced constipation, surgical bowel preparation and postpartum constipation are low; colonoscopy and capsule preparation and recovery after surgery are mixed; children and kidney or intensive-care use are very low; colonoscopy preparation in children is against.
What is uncertain: long-term safety, how often liver injury and potassium loss happen, whether long use harms the bowel nerves or raises cancer risk, and safety in pregnancy and breastfeeding, where sources disagree.
What has not been studied: long trials beyond a few weeks, placebo-controlled trials in children, senna for weight loss, and most medicine interactions beyond those named in the EU monograph.
What we could not verify: the full LiverTox chapter (only the abstract was read), the FDA, WHO, German Commission E and IARC positions, EU food-law limits, and the traditional history.
Products: no survey of sennoside content, metals or pesticides in senna products was found; aflatoxin was found in pods in one study.

How new research is added

New studies are found by a saved PubMed search and are placed in a review queue. A person reads each one before it changes any evidence rating or safety wording. New publications never change ratings automatically.

Lab markers

What changed in blood or saliva tests during trials. A changed number is not the same as feeling or being healthier, and we give no "normal ranges".

Other 8

▲

Spontaneous bowel movements per week

Raised in trials

The number of times a person passes stool without help from an enema or extra laxative.

Moderate certainty

Results and what it means

Why it was measured

Main outcome of most constipation trials.

Statistical vs. clinical meaning

More bowel movements is a measured count, but how many extra movements matter to a person is not shown in these abstracts.

Safety implication

A laxative that works too well gives diarrhoea and potassium loss.

Study	Result	People	Product
⁴⁰	Change in spontaneous bowel movements was significantly greater on senna and on magnesium oxide than on placebo (P < 0.001); exact numbers not in the abstract	90 adults with chronic idiopathic constipation	Senna 1.0 g a day for 28 days
²⁶	4.5 vs 2.2-1.9 bowel movements a week with senna plus bulk laxative vs lactulose (p < 0.05)	30 geriatric long-stay patients	Bulk laxative plus senna, 14.8 g a day
⁴⁷	Daily bowel frequency 0.8 (95% CI 0.7 to 0.9) vs 0.6 (0.5 to 0.7) with lactulose	77 long-stay elderly patients	Senna-fibre 10 ml a day, crossover
⁴¹	Complete spontaneous bowel movements a week rose by 2.1 with senna plus ispaghula husk and by 1.3 with lactulose; no difference between them (P = 0.276)	22 people with pre-dialysis chronic kidney disease	Senna plus ispaghula husk, 14 days

^{40 26 47 41}

↕

Constipation symptom and quality-of-life scores (PAC-SYM, PAC-QOL)

Mixed results in trials

Questionnaires on stool problems and how constipation affects daily life.

Low certainty

Results and what it means

Why it was measured

Show how people feel, not just counts of stools.

Statistical vs. clinical meaning

Questionnaire gains were seen against placebo but not against another active drug.

Safety implication

None specific.

Study	Result	People	Product
⁴⁰	Quality of life improved on senna vs placebo (P < 0.05)	90 adults with chronic constipation	Senna 1.0 g a day, 28 days
³⁴	PAC-SYM change -0.36 senna vs -0.20 lubiprostone (P = 0.61); PAC-QOL 0.37 vs 0.29 (P = 0.61); abdominal pain fell more with senna (P = 0.04)	56 adults on opioids after orthopaedic surgery	Senna 2 capsules daily, 6 days

^{40 34}

▼

Need for enema, extra laxatives or an X-ray

Lowered in trials

Extra treatments or imaging used when constipation is not settling.

Low certainty

Results and what it means

Why it was measured

Shows whether constipation became a problem despite treatment.

Statistical vs. clinical meaning

One retrospective cohort and one small trial with a high rescue rate.

Safety implication

None specific.

Study	Result	People	Product
¹⁹	Senna linked to lower hazard of enema (HR 0.31, 95% CI 0.11 to 0.91), abdominal X-ray (HR 0.74, 0.55 to 0.98) and a composite problem measure (HR 0.70, 0.56 to 0.88)	586 matched hospitalised young cancer patients on opioids	Senna started within 2 days of opioids vs other oral bowel medicines
³⁴	75% in both senna and lubiprostone groups asked for rescue treatment	56 adults after orthopaedic surgery	Senna vs lubiprostone, 6 days

^{19 34}

●

Faecal loading on abdominal X-ray (Leech score)

No clear change in trials

How much stool is seen in the bowel on an X-ray, scored 0 to 15.

Very low certainty

Results and what it means

Why it was measured

An objective measure of whether stool is being cleared in children.

Statistical vs. clinical meaning

Two trials disagree and both are tiny.

Safety implication

Not applicable.

Study	Result	People	Product
⁴²	Mean Leech scores 6.67 sennosides, 6.80 magnesium hydroxide, 5.80 PEG (p = 0.841); clean in 40%, 46.7% and 60% (p = 0.655)	15 patients with corrected anorectal malformation	Sennosides 21-day period, crossover
⁵⁷	Trial stopped early because interim analysis showed a benefit toward senna (p = 0.026); numbers not given in the abstract	Children with repaired anorectal malformation	Senna up to 38.7 mg a day vs PEG

^{42 57}

↕

Bowel cleanliness score (Boston Bowel Preparation Scale and others)

Mixed results in trials

Doctors score how clean the bowel looks, so the test can be done.

Mixed findings

Results and what it means

Why it was measured

Main outcome of preparation trials.

Statistical vs. clinical meaning

The scale rates how clean the bowel looks, not whether more adenomas are found.

Safety implication

Abdominal pain is common with senna.

Study	Result	People	Product
⁶⁸	Cleanliness OR 1.02 (95% CI 0.63 to 1.67) for senna regimens vs others	11 trials, 3,343 adults	Senna regimens
¹⁶	Mean BBPS 7.35 vs 6.57; adequate 89.9% vs 73.8% (P = 0.001)	474 outpatients	Split high-dose senna vs 4 L PEG
³³	Adequate preparation 86% with 1 L PEG-Asc plus senna vs 92% with linaclotide (P = 0.001)	1,464 outpatients	Senna arm as comparator
³²	Adequate 88% vs 89% (P = 1.00); BBPS 7.1 vs 7.2	344 outpatients	1 L PEG-Asc plus senna 24 mg vs 2 L PEG-Asc

^{68 16 33 32}

●

Adenoma detection rate

No clear change in trials

The share of colonoscopies that find a precancerous polyp.

Low certainty

Results and what it means

Why it was measured

Shows whether the preparation helps the real purpose of the test.

Statistical vs. clinical meaning

Not significantly different in one trial.

Safety implication

Not applicable.

Study	Result	People	Product
²⁵	34.9% vs 41.8% (P = 0.3795) senna vs super-low-volume PEG groups	244 analysed (122 per group)	Senna 1 g a day for 3 days plus 2 L PEG

²⁵

▼

Time to the first bowel movement or return of gut function

Lowered in trials

Days after surgery or delivery until the first stool (and eating).

Low certainty

Results and what it means

Why it was measured

Shows recovery.

Statistical vs. clinical meaning

A day sooner is meaningful, but trials are few and used combination regimens.

Safety implication

Cramps.

Study	Result	People	Product
⁴⁸	3.00 vs 4.05 days with senna plus docusate vs placebo (P < .002)	96 women after pelvic reconstructive surgery	Senna 8.6 mg plus docusate 50 mg
¹⁷	GI-2 median 2 vs 3 days (P = 0.029)	170 adults after colorectal surgery	Docusate with senna and macrogol
⁶⁹	First bowel movement within 24 hours RR 2.90 (95% CI 2.24 to 3.75) in one trial of 471 women	Postpartum women	Senna vs placebo

^{48 17 69}

↕

Small-bowel cleansing for capsule endoscopy

Mixed results in trials

How clean the small bowel looks to the camera.

Mixed findings

Results and what it means

Why it was measured

Shows picture quality.

Statistical vs. clinical meaning

Two small trials disagree.

Safety implication

Preparation was less comfortable in one trial.

Study	Result	People	Product
¹³	Whole and distal small bowel cleansing significantly better in the senna group; proximal bowel no difference	180 patients	Fasting plus senna 3 g three times a day with mannitol and simethicone
⁴⁹	No difference in view quality with Citramag plus senna vs standard preparation (P = .62)	150 patients	Citramag plus senna the evening before

^{13 49}

Safety

What studies and official sources say about side effects, medicines and who should check first. Each point shows what kind of evidence it comes from.

Main points to know 10

Short-term use only: the EU says no more than 1 week. The EU herbal monograph for senna leaf says not to use it for more than 1 week, and that taking it two to three times during that week is usually enough. If it is needed every day, the cause of the constipation should be looked at. It should be used only if a change of diet or a bulk-forming fibre has not worked. Individual product labels may differ; check the label and ask a pharmacist. Authoritative guidance ⁸⁰
Long use can lead to dependence on laxatives, and reviews disagree on gut damage. The EU monograph warns that using stimulant laxatives for more than a short time may lead to poor bowel function and dependence on laxatives. Some reviews of the research looked for lasting nerve or muscle damage in the bowel and found no convincing evidence of it with senna (a 2009 toxicology review and a 2024 critical review), and a children's review found no tolerance. The question is not settled for years of daily use, and the safe course is to follow the short-term advice. Authoritative guidance ^{80 39 77 72}
Low potassium and fluid loss, especially with heart or water-pill medicines. Long-term or high use causes loss of water and salts, including potassium. The EU monograph says low potassium strengthens the effect of heart medicines called cardiac glycosides (such as digoxin) and interacts with heart rhythm medicines, and that water pills, steroid tablets and licorice root can add to potassium loss. Anyone taking these should talk to a doctor first. A Taiwanese study of heart failure patients found sennoside use linked to a 1.61-fold higher chance of being admitted with digoxin toxicity. Authoritative guidance ^{80 74}
Not for pregnancy, breastfeeding or children under 12 under the EU monograph. The EU monograph contraindicates senna leaf in pregnancy (because some related anthranoids such as emodin and aloe-emodin were genotoxic in lab tests), in breastfeeding (small amounts of the active metabolite rhein pass into milk) and in children under 12. Other sources disagree about breastfeeding: the US LactMed record (abstract) says usual doses are acceptable, and one review calls senna a safe laxative in pregnancy. These differences are real and should be discussed with a doctor. Authoritative guidance ^{80 1 56 18}
Do not use with a blocked bowel or unexplained belly pain. Senna must not be used with intestinal obstruction or narrowing, loss of bowel muscle tone, appendicitis, inflammatory bowel disease, abdominal pain of unknown cause or severe dehydration. Pain, nausea and vomiting can be signs of a blockage, and a laxative could make things worse. Authoritative guidance ⁸⁰
Harmless dark colon lining (melanosis coli) is common with long use. Long use stains the lining of the large bowel dark (pseudomelanosis coli). It usually fades after stopping: in one case it was gone 7 months after a woman stopped senna after 5 years. In children with constipation, sennoside use was linked to melanosis coli (adjusted OR 13.88), but it was not linked to worse bowel movement or to surgery. It is a marker of long laxative use. Case report ^{80 15 14}
Liver injury has been reported with high doses taken for long periods. Case reports describe severe liver injury in people who took very large amounts for years, including one woman who drank 1 L a day of tea made from 70 g of senna pods for over 3 years. LiverTox says senna is generally safe and well tolerated but can cause clinically apparent liver injury in high doses for longer than recommended. The EU monograph says chronic overdose of anthranoid medicines may lead to toxic hepatitis. No frequency is known. Case report ^{2 71 62 22 80}
Cancer question: lab signals, no clear human link. Some related anthraquinones (emodin, aloe-emodin, rhein) were mutagenic in lab tests, and in a 32-patient study a single high dose of purified senna extract raised cell turnover in the colon lining. But senna pods did not cause tumours in a 2-year rat study, the US National Toxicology Program found no evidence of carcinogenic activity in a 40-week study in p53 mice, and a 2022 meta-analysis of observational studies found no statistically significant link between anthraquinone laxatives and bowel cancer (OR 1.41, 95% CI 0.94 to 2.11; the authors say more good studies are needed). Constipation itself may affect cancer risk and confuses the studies. Meta-analysis ^{31 37 43 83 86 45 61 39 77}
Children: nappy-area blistering and accidental ingestion. Senna stool left on the skin can cause blisters in children who wear nappies, which can look like burns. A review found 28 cases in the literature and 2.2% of 640 children treated at one centre, mostly on higher doses with long stool contact. Keep senna chews and tablets out of children's reach. Case series ^{72 46 36}
Quality problems: mould toxins in pods and mixed-up species. Aflatoxin B1 was found well above the 2 ug/kg limit in most late-harvest senna pod samples in one Indian study. Different species of Senna and Cassia are traded and not all are safe: the seeds of a different species (Senna occidentalis) cause serious liver, muscle and brain poisoning in children. Laboratory research ^{64 60 78}

Side effects 8

Effect	How often	Severity and recovery	Evidence
Abdominal pain, cramps and spasm The EU monograph says pain is especially likely in people with irritable colon, and that dose reduction is needed.	Not known (EU monograph). In trials: 70.9% with split high-dose senna vs 43% with PEG for bowel preparation; abdominal cramps RR 4.23 (95% CI 1.75 to 10.19) postpartum; about 13% minor effects in children	mild to moderate Usually eases when the dose is lowered or stopped	Controlled trial ^{80 16 69 72}
Loose or liquid stools, diarrhoea Major sign of overdose or abuse is griping pain and severe diarrhoea with fluid and electrolyte loss.	Not known (EU monograph)	mild to severe with overdose Settles after stopping	Authoritative guidance ⁸⁰
Water and salt (electrolyte) loss, low potassium Long term use may also cause albuminuria and haematuria (protein or blood in urine) according to the monograph.	Not known	moderate; can be serious in elderly, heart or kidney patients Resolves with fluids and stopping; potassium should be checked	Authoritative guidance ⁸⁰
Allergic reactions: itching, hives, rash The monograph lists pruritus, urticaria and local or generalised exanthema.	Not known	mild to moderate; severe reactions possible Resolve after stopping	Authoritative guidance ⁸⁰
Dark colon lining (pseudomelanosis coli) Not by itself harmful; see cancer question.	Linked to sennoside use in children (adjusted OR 13.88, 95% CI 4.05 to 47.57)	none (a marker of long use) Usually recedes after stopping; resolved by 7 months in a case report	Cohort study ^{80 14 15}
Yellow or red-brown urine Caused by metabolites; pH dependent.	Not known	not clinically significant Ends after stopping	Authoritative guidance ⁸⁰
Nappy-area or perineal blistering in children Linked to long stool-skin contact and higher doses.	2.2% of 640 children at one centre	moderate Heals with treatment	Case series ^{72 46 36}
Tolerance or reduced effect EU monograph still warns of dependence; reviews found no clear evidence of tolerance.	Not found in a review of child studies	mild -	Narrative review ^{72 80}

Liver

LiverTox (abstract read) says senna is generally safe and well tolerated, but can cause clinically apparent liver injury when used in high doses for longer than recommended. Published cases include a 52-year-old woman who drank about 1 L a day of tea made from 70 g of senna pods for over 3 years and developed acute liver failure with kidney damage (she recovered with supportive care, and possible metal contamination was noted); a 77-year-old man with chronic use and cholestatic hepatitis on biopsy; a 3-year-old with chronic senna use and severe hepatitis with low blood counts; and two further letters (1991, 2004) whose details were not read. The EU monograph says chronic overdose may lead to toxic hepatitis. A rat study of a 60% sennoside leaf extract found no liver toxicity at 12 and 58 mg per kg a day. The LiverTox likelihood score was not read. ^{2 71 62 22 6 58 73 12 80}

How often. No frequency was found. LiverTox describes injury as occurring with high doses for longer than recommended; the published cases are very few compared with how widely senna is used (no figure for either was found).

Monitoring. No agency monitoring advice was read. Stop and see a doctor the same day for yellow skin or eyes, dark urine, pale stools, severe tiredness or pain in the upper right belly.

This is a safety connection. It is not evidence that Senna supports liver health.

Medicines and supplements 6

With	Why it matters	Importance	Evidence	What to do
Digoxin and other cardiac glycosides prescription	Laxative-induced potassium loss (low potassium) strengthens the effect of cardiac glycosides on the heart.	The EU monograph says people taking cardiac glycosides must consult a doctor before using senna. A Taiwanese case-control study of 524 hospital cases of digoxin toxicity and 2,502 matched controls found sennoside use in the previous 14 days linked to a 1.61-fold increase (95% CI 1.15 to 2.25), and 1.93 (1.27 to 2.94) at an average 24 mg a day or more.	Authoritative guidance Low certainty ^{80 74}	Do not use without talking to the doctor who manages your heart medicine; potassium may need checking.
Heart rhythm medicines (antiarrhythmics) and medicines that prolong the QT interval prescription	Low potassium raises the risk of rhythm problems with these medicines.	Named in the EU monograph's warning: such patients must consult a doctor first.	Authoritative guidance Low certainty ⁸⁰	Ask a doctor or pharmacist before use.
Diuretics (water pills) prescription	Both cause potassium loss; together they can lower potassium further.	EU monograph says concomitant use may enhance potassium loss.	Authoritative guidance Low certainty ⁸⁰	Talk to a doctor; potassium may need checking.
Corticosteroid tablets (adrenocorticosteroids) prescription	Steroids also cause potassium loss.	EU monograph says concomitant use may enhance potassium loss.	Authoritative guidance Low certainty ⁸⁰	Talk to a doctor before use.
Licorice root (liquorice) herb	Licorice can lower potassium; with a laxative the loss may add up. In rats, sennoside A and its metabolites reduced the absorption of the licorice compound glycyrrhetic acid.	EU monograph names licorice root with potassium loss. The rat absorption study is a different mechanism and is not shown in people.	Authoritative guidance Low certainty ^{80 38}	Avoid combining without advice; licorice teas and sweets count.
Other laxatives, including other anthranoid herbs (aloe latex, cascara, rhubarb, frangula) herb	Additive laxative effect (pharmacological reasoning).	Not directly tested in any source read; the EU monograph treats all hydroxyanthracene laxatives alike for potassium loss.	Pharmacological theory Not enough evidence ⁸⁰	Do not combine stimulant laxatives without a doctor's advice.

Who should check first 12

Situation	Advice	Evidence
Allergy to senna or its constituents	Avoid. Listed as a contraindication (hypersensitivity).	Authoritative guidance ⁸⁰
Intestinal obstruction or narrowing, loss of bowel tone (atony)	Do not use.	Authoritative guidance ⁸⁰
Appendicitis or unexplained abdominal pain; undiagnosed, acute or persistent gut complaints (nausea, vomiting)	Do not use unless a doctor advises; these can be signs of blockage (ileus).	Authoritative guidance ⁸⁰
Inflammatory bowel disease (Crohn's disease, ulcerative colitis)	Do not use.	Authoritative guidance ⁸⁰
Severe dehydration with water and salt loss	Do not use.	Authoritative guidance ⁸⁰
Faecal impaction	Do not use unless advised by a doctor.	Authoritative guidance ⁸⁰
Pregnancy	Contraindicated by the EU monograph because experimental data suggest genotoxic risk of several anthranoids (emodin, aloe-emodin). One narrative review calls senna a safe laxative in pregnancy; this disagrees with the EU position, so talk to a doctor.	Authoritative guidance ^{80 56}
Breastfeeding	Contraindicated by the EU monograph because rhein passes into milk in small amounts. In 20 breastfeeding women, 94% of milk samples had rhein below 10 ng/ml and none of the infants had abnormal stool; LactMed (abstract) says usual doses are acceptable. A 1988 monkey study found milk transfer far below a laxative dose. Talk to a doctor.	Authoritative guidance ^{80 1 18 10 9}
Children under 12	Contraindicated by the EU monograph. Children's doctors do prescribe senna (a review of 640 children treated at one centre); the contraindication is the EU herbal monograph's position.	Authoritative guidance ^{80 72}
Kidney disorders	Be aware of possible electrolyte imbalance; ask a doctor.	Authoritative guidance ⁸⁰
Incontinent adults wearing pads	Change pads more often to prevent long skin contact with stool.	Authoritative guidance ⁸⁰
Using laxatives for weight loss or 'detox'	Avoid. No randomised trial of senna for weight loss was found; the review of sennoside A notes use as a 'slimming health food' and risks with large long-term doses. Misuse is a recognised cause of electrolyte loss.	Authoritative guidance ^{30 80}

Overdose, product quality and regulators

Summary. Used briefly at label strength, senna is generally well tolerated; the common problems are cramps and loose stools. Risks rise with high doses and long use: water and salt loss, kidney changes in animals, liver injury cases and a question about cancer. The EU monograph notes there are no preclinical data for senna leaf itself and uses senna pod data.

Animal. Rat 2-year gavage study of senna fruits (Mitchell 2006): doses 25, 100 and 300 mg per kg a day; no treatment-related tumours; all treated groups had dark kidneys with tubular pigment and changes, and mild hyperplasia of the colon and caecum, reported as reversible in an earlier 13-week study. EU monograph: in a 90-day rat study of senna pods (100 to 1500 mg per kg) minor reversible colon epithelium thickening, forestomach changes and, from 300 mg per kg, reversible kidney changes with pigment; no change in the colon nerve plexus; no no-effect level was found. US NTP: no evidence of carcinogenic activity in p53+/- mice at 100 to 10,000 ppm for 40 weeks; colon and caecum hyperplasia at the high doses.

Human doses studied. Trials used senna 1.0 g a day for 28 days (adult constipation), high-dose split sennoside regimens of 1,000 mg for bowel preparation, and 3-day courses; a children's centre used up to 150 mg a day. The EU dose is a daily single dose at night equal to 10 to 30 mg hydroxyanthracene derivatives (calculated as sennoside B), for adults and over-12s only; amounts for individuals are for a doctor or pharmacist.

High dose or long term signals. Long use: dependence, electrolyte loss, albuminuria and haematuria (EU monograph); melanosis coli; case reports of liver injury; in rats senna extract raised kidney and liver weight at diarrhoea-causing doses.

Overdose response. EU monograph: griping pain and severe diarrhoea with loss of fluid and electrolytes; supportive treatment with generous fluids; monitor electrolytes, especially potassium, which is especially important in the elderly; chronic overdose of anthranoid medicines may lead to toxic hepatitis.

Genotoxicity. EU monograph: senna pods, extracts and several hydroxyanthracene derivatives (except sennosides, rhein and sennidins) were mutagenic and genotoxic in several in vitro tests, but for senna and aloe-emodin this was not proven in living systems. NTP: sennosides A and B were not mutagenic in bacteria; two of four senna samples and rhein were mutagenic in some strains; no increase in micronuclei in mouse blood after 40 weeks. A 1997 review judged senna laxatives not to pose a genotoxic risk to humans at prescribed use.

Toxic plant parts. The leaflets and pods (fruits) are used; pods have the same constituents in larger amounts (Franz review). The seeds of a different species, Senna occidentalis (coffee senna), are toxic and have caused fatal liver-muscle-brain injury in children; do not confuse the two.

No survey of heavy metals or pesticides in senna products was found. One Indian study found aflatoxin B1 (a mould poison) above the limit in most late-harvest senna pod samples. One liver-failure case with very high pod tea intake had cadmium in the urine, which suggests contamination but was not proven. Different species can be sold under senna names.

Aflatoxin B1 in senna pods. In 229 pod samples over 3 years, late-harvest samples averaged 52.4 ug/kg (range up to 206); 37 of 48 exceeded the 2 ug/kg limit cited; levels rose during drying (mean 4 ug/kg) and storage (mean 18.1 ug/kg). ⁶⁴

Possible metal contamination in a tea case. Large amounts of cadmium were transiently found in the urine of a woman with liver failure who drank pod tea; the authors could not check whether the tea was contaminated. ⁷¹

Other species. Senna italica has a similar chemical profile to S. alexandrina (sennoside A 1.00% vs 1.85%), with lab liver-cell toxicity at high concentrations in both; the seeds of S. occidentalis are poisonous. ^{78 60}

Product strength varies. No survey of sennoside content in finished products was found; the EU monograph requires standardised preparations and a European Pharmacopoeia quality standard (ref. 0206). ⁸⁰

Body	Action	Date
European Medicines Agency, Committee on Herbal Medicinal Products (HMPC) (European Union)	EU herbal monograph (EMA/HMPC/625849/2015) on Senna alexandrina Mill. leaf: well-established use for short-term occasional constipation; not for use over 1 week; contraindicated in pregnancy, lactation and under 12; warnings on dependence and potassium loss. source	2018-09-25
US National Toxicology Program (United States)	Genetically modified model report 15: no evidence of carcinogenic activity of senna in p53+/- mice. source	2012-04
NIH LiverTox (United States)	Chapter 'Senna': generally safe and well tolerated, but can cause clinically apparent liver injury at high doses for longer than recommended. source	2020-04-01
NIH LactMed (United States)	Chapter 'Senna': usual doses are acceptable during breastfeeding; an early uncontrolled report found more infant diarrhoea but controlled studies did not. source	2024-11-15

When to get medical help

Swelling of the face, lips or throat, trouble breathing or widespread hives after senna: call emergency services.
Severe belly pain, a swollen belly, repeated vomiting or no stool or gas after taking senna: possible blockage; get urgent medical care and do not take more.
Severe or watery diarrhoea with dizziness, weakness, muscle cramps, very dark urine or a fast or irregular heartbeat: possible fluid and potassium loss; seek care the same day, especially if you take digoxin, water pills or heart rhythm medicines.
Yellow skin or eyes, dark urine, pale stools, severe tiredness or pain in the upper right belly: stop senna and see a doctor the same day.
Blood in the stool or constipation that returns or worsens after short use: see a doctor; do not keep taking laxatives.
A child with blisters or raw skin in the nappy area after senna: stop it and call a doctor.
Constipation that needs a laxative every day, or has a new change in bowel habits: see a doctor to find the cause.
Anyone pregnant or breastfeeding who has taken senna and has strong cramps, bleeding or diarrhoea in the baby: call a doctor.

Stop the supplement and contact a clinician or emergency service. In the US, Poison Control is 1-800-222-1222.

General information only, not medical advice. Ask a clinician or pharmacist before use, especially with medicines, in pregnancy or with a health condition. See the Natural Remedy Safety guide.

Frequently asked questions

Does senna work for constipation?

Yes, for short-term constipation in adults, with moderate certainty. In one 28-day placebo-controlled trial of 90 adults, 69.2% improved on senna against 11.7% on placebo. A review graded it as good evidence, but that review was paid for by a laxative maker and the trial is small. For other groups the evidence is weaker.

^{40 52}

How long is it safe to use senna?

Only briefly. The EU herbal monograph says not to use senna leaf for more than 1 week, and that two to three uses in that week are usually enough. Longer use may lead to dependence on laxatives and to potassium loss. If you need a laxative every day, see a doctor to find the cause. Ask a doctor or pharmacist about amounts.

⁸⁰

Is senna addictive, and will it make my bowel lazy?

The EU monograph warns that long use may lead to impaired bowel function and dependence on laxatives. Reviews looked for lasting nerve or muscle damage and found no convincing evidence, and a children's review found no tolerance, but long-term trials are missing. The safe course is to follow the short-term limit.

^{80 39 77 72}

Which medicines does senna interact with?

The EU monograph names heart medicines called cardiac glycosides (such as digoxin), heart rhythm drugs, medicines that prolong the QT interval, water pills (diuretics), steroid tablets and licorice root. Senna can lower potassium, and low potassium makes these drugs act differently. A Taiwanese study linked sennosides to a 1.61-fold higher chance of digoxin toxicity. Ask a doctor or pharmacist first.

^{80 74}

Is senna safe in pregnancy or when breastfeeding?

The EU monograph contraindicates it in both, citing genotoxic findings for related compounds and small amounts of rhein in breast milk. Other sources disagree: the US LactMed abstract says usual doses are acceptable while breastfeeding, and one review called senna a safe laxative in pregnancy. Because the advice differs, talk to a doctor or midwife.

^{80 1 56 18}

Can children take senna?

The EU monograph says not under 12 for the herbal product. Children's doctors do prescribe senna, but evidence is thin: a Cochrane review found only one small senna trial. Nappy-area blistering can occur and was seen in 2.2% of 640 children at one centre. Do not give senna to a child without medical advice.

^{80 21 72}

Can senna damage the liver?

Rarely, and at high doses over long periods. LiverTox says injury can occur when used in high doses for longer than recommended, and cases include a woman who drank 1 L a day of senna pod tea for over 3 years. How often it happens is not known. Stop and see a doctor for yellow skin or eyes or dark urine.

^{2 71 62 22}

Does senna cause colon cancer or melanosis coli?

Melanosis coli, a harmless dark staining of the colon lining, is common with long use and usually fades after stopping (one case resolved in 7 months). Cancer: senna did not cause tumours in a 2-year rat study or in a 40-week study in p53 mice, and a 2022 meta-analysis of studies found no statistically significant link (OR 1.41, 95% CI 0.94 to 2.11), though the authors want better studies. Some related compounds were genotoxic in lab tests.

^{15 14 37 83 31}

Does senna work for cleaning the bowel before a colonoscopy?

It can, with mixed results. A meta-analysis of 11 trials found cleanliness similar to other preparations with better tolerance, but belly pain was common and some trials favoured PEG or newer combinations. In children, PEG was better. Your endoscopy team chooses the preparation.

^{68 16 75}

Is senna good for constipation caused by opioid painkillers?

It is widely used, but trials are small. In 70 cancer outpatients PEG gave slightly more satisfactory days than sennosides, which the authors called weak evidence. Reviews could not separate laxatives clearly. Ask your care team.

^{24 27 11}

Does senna help after surgery or after childbirth?

Maybe. Regimens containing senna with docusate shortened the time to the first bowel movement by about 1 day in two trials, but senna alone did not help after shoulder surgery. After childbirth a Cochrane review found low-certainty evidence of a sooner first bowel movement with more cramps. Do not use senna after bowel surgery without surgical advice.

^{17 48 76 69}

Can senna tea help with weight loss?

No trial was found that supports it. A review of sennoside A notes use as a slimming food but lists risks with large long-term doses. Misuse of laxatives can cause potassium loss and dependence, and senna pods or tea have been tied to liver injury in case reports. Use senna only for constipation and only short term.

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Editorial transparency

Written by: AlternativeMed editorial team. Research compiled with AI assistance, then checked against PubMed records.
Medical review: None. This page has not been reviewed by a physician or pharmacist.
First published: 2026-10-25
Last substantive update: 2026-10-25
How we research: We searched PubMed, read the EU herbal monograph on senna leaf in full, the US National Toxicology Program abstract, the abstracts of the LiverTox and LactMed senna records, and checked plant names in GBIF and the NCBI taxonomy and compounds in PubChem. Only abstracts were read for nearly all studies. Some sources were not verified: the full LiverTox chapter, the FDA, WHO and German Commission E texts, any IARC position, EU food-law limits and the traditional history. Certainty ratings are the compiler's own reading, not formal grades unless a review gave them. No study is cited that we could not verify.
How we rate evidence: See "How we rate evidence" in the Evidence tab.
Independence: No product is promoted on this page. No affiliate links are shown. If one is added later it will be labelled and kept apart from the evidence.

Sources 86

Each source was opened and checked. Where we read only the abstract, it says so. The small numbers in the text point here.

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. GBIF Backbone Taxonomy: Senna alexandrina Mill. (usageKey 2958032). . . (full-text)
. NCBI Taxonomy: Senna alexandrina (taxid 72402). . . (full-text)
. NTP Genetically Modified Model Report 15: toxicology and carcinogenesis study of senna in p53 haploinsufficient mice (feed), April 2012. . . (summary-only)
. PubChem compound records for sennoside A (CID 73111), sennoside B (91440), sennosides C and D (46173829, 46173830), sennidin A (92826), rhein (10168), rheinanthrone (119396), aloe-emodin (10207), emodin (3220), kaempferol (5280863), isorhamnetin (5281654). . . (full-text)
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Education, not medical advice. This page is for general information. It does not diagnose or treat any condition and is not a substitute for care from a qualified health professional. Natural does not automatically mean safe. Ask a clinician or pharmacist before changing your care, especially if you take medication, are pregnant or breastfeeding, or have a health condition.