Which herb is contraindicated in pregnancy, intestinal obstruction, and inflammatory bowel disease?

• A. Cascara Sagrada
• B. Rubus idaeus
• C. Salix alba
• D. Sambucus nigra

Answer: (A)

Stimulant laxatives that irritate the intestinal lining are unsafe in pregnancy, intestinal obstruction, and inflammatory bowel disease. Cascara Sagrada contains anthraquinone glycosides that provoke bowel movements by irritating the colon and increasing water and electrolyte secretion. Those strong effects can trigger uterine contractions in pregnancy, worsen obstruction by stimulating a bowel that is already blocked, and aggravate inflammation and cramping in inflammatory bowel disease. For these reasons it is avoided in all three conditions. The other herbs listed don’t carry the same combined contraindication: red raspberry leaf is sometimes used in later pregnancy, willow bark contains salicylates and isn’t universally contraindicated in these three, and elderberry isn’t specifically linked to these three conditions in the same way.