She is treated with morphine for analgesia and evaluated by orthopedic surgery for surgical repair. The hospitalist recognizes that this patient is at high risk for constipation and orders docusate for prevention of constipation. Constipation is a highly prevalent problem in all practice settings, especially in the hospital, affecting two out of five hospitalized patients. Furthermore, the inpatient population is aging in parallel with the general population and constipation is more common in the elderly, likely owing to a combination of decreased muscle mass and impaired function of autonomic nerves.
One of the most commonly prescribed agents, regardless of medical specialty, is docusate, also known as dioctyl sulfosuccinate or by its brand name, Colace.
Medical and surgical admissions shared similar proportions of usage, with an average of 10 doses of docusate per admission across 17, admissions. Furthermore, half of the patients were prescribed docusate upon discharge. Docusate is thought to act as a detergent to retain water in the stool, thereby acting as a stool softener to facilitate stool passage. Physicians have prescribed docusate for decades, and attendings have passed down the practice of prescribing docusate for constipation to medical trainees for generations.
The initial docusate studies showed promise, as it softened the stool by increasing its water content and made it easier to pass through the intestines. Despite common practice, the efficacy of docusate as a stool softener has not been borne out by rigorous scientific data.
On the contrary, multiple randomized controlled trials have failed to show any significant efficacy of this drug over placebo Table. The initial trial in studied 34 elderly patients on a general medical ward for prophylaxis of constipation. The number of bowel movements and their character served as the measured outcomes.
The study demonstrated no statistically significant differences in the frequency and character of bowel movements between the docusate and placebo groups. Another trial in studied 46 elderly, institutionalized patients with chronic functional constipation. Patients received enemas or suppositories if required.
According to the authors, none of the therapies appeared to have a significant effect on stool consistency. The authors hypothesized that the higher dose given to the docusate calcium arm may have been the reason for the apparent efficacy in this cohort. As such, studies with higher doses of docusate calcium would be reasonable.
A third study in compared docusate sodium mg three times daily versus placebo in six healthy patients with ileostomies and six healthy volunteers. The following table lists some of the milder as well as the more serious side effects of stool softeners and other laxatives. The more serious side effects are usually much less common.
If you do have serious side effects, contact your doctor immediately. Laxatives can also interact with other drugs, vitamins, and supplements that you take. Your doctor may even recommend a specific laxative, depending on the medication you take. For example, mineral oil can interact with stool softeners.
You may have heard that you can use laxatives to lose weight. However, there are no studies that support the use of laxatives for weight loss. Further, using higher doses of laxatives for long periods can result in a much higher risk of the following effects, some of which can be severe:.
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Health Conditions Discover Plan Connect. Stool Softeners vs. Introduction Constipation can be extremely uncomfortable, and it can affect anyone due to many different causes.
Stool softeners and laxatives. For instance, people who are on medication to lower their sodium levels or are taking other mineral-based medications, such as medicines to reduce calcium in the kidneys, should avoid saline laxatives. Saline laxatives are useful for short-term constipation. Using them for extended periods may lead to dehydration or cause an imbalance in other minerals.
Doctors may recommend laxatives containing oils, such as mineral oil for difficult short-term constipation, but they are not suitable for regular use. The oils in these laxatives may stick to fat-soluble vitamins and make them impossible to digest.
The stimulating effect in these laxatives makes the stool move faster through the colon while increasing the liquid in the stool. Many popular over-the-counter brand names contain stimulant laxatives. Stimulant laxatives are not safe for regular use. Using them regularly may cause the body to become dependent on the laxative to have a bowel movement. Doctors may prescribe guanylate cyclase-C agonist laxatives in cases of chronic constipation that has no known cause.
These laxatives, along with lifestyle changes, may offer a solution for people who suffer from chronic constipation. Young children should not use them. Stool softeners may be best when a person does not need immediate relief but is looking to regulate their bowel movements within the next few days. The type of laxative the doctor recommends may also change based on how quickly the person needs relief. Individual result times may vary, but in general:.
According to a study looking at constipation in older adults:. Doctors often recommend that people struggling with constipation make lifestyle changes to help ease their symptoms. Many people can find relief from constipation by drinking plenty of water and getting regular exercise. People can also benefit from eating more fiber.
A study from reports that increasing dietary soluble fiber intake speeds up the transit time and relieves symptoms in people with slow-moving constipation.
People can increase their daily fiber intake by including more fruits and vegetables in their diet. Fiber-rich foods that can help with constipation include:.
All laxatives come with the risk of side effects. Some side effects are temporary, while others may be severe enough to warrant a change in medication. Misusing laxatives, such as taking laxatives for extended periods, may cause severe and potentially dangerous symptoms. Allergic reactions are also possible with all laxatives. Anyone who is having an allergic reaction or is unsure about their reaction should stop using the laxative and call their doctor.
Importantly, laxatives may interact with other drugs a person is taking. People with constipation who take other drugs should speak with a doctor or pharmacist before taking any laxative. Occasional constipation is normal. Both stool softeners and other laxatives may provide temporary relief from symptoms, and the choice between them may depend on how quickly a person needs relief.
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