Dealing with Constipation

Q: I finally had my hip replaced last week. My surgeon recommended taking a stool softener for a couple of weeks to prevent constipation. Is that the same as a laxative?

Many surgeons advise their patients to take a stool softener, expecting it to help you avoid the discomfort of constipation. However, this practice has been called into question because there is very little evidence proving that it works.

Laxatives encourage the movement of stool through your intestines, preventing or relieving the pain and pressure of constipation. The word laxative means “to loosen," similar to the word “relax” and "lax," meaning to act loose or relaxed. A laxative works to “loosen” your bowels, relieving constipation.

Stool softeners lubricate your stool, making it softer, but don’t prevent or relieve constipation.

After swallowing a bite of food, it moves through a series of tubes, called the digestive tract. In your stomach, highly acidic gastric juices secreted by cells in its lining start breaking down your food into a form that can be absorbed by your body. The most liquid mass of food then moves from your stomach into your small intestine to begin the process of absorbing its vital nutrients.

Your intestines are lined with special cells designed to absorb any nutrients, medicines, and water. Other muscles run the entire length of your intestines, squeezing as they keep the mass of food moving through. Whatever is leftover becomes stool or feces.

The longer it takes food to move from your small intestine to your rectum, the more water will be pulled out of your stool. This makes stool smaller, harder, and more painful to eliminate. A stool softener draws moisture into the food mass and lubricates it, helping ease the discomfort of constipation. The most common stool softeners are docusate and mineral oil.

Docusate is a surfactant, very much like a detergent or soap, and helps water move into your stool. Docusate doesn't directly stimulate the muscles of your intestine to eliminate feces. Instead, it can replace some water absorbed into your body as it moves through your intestine. Docusate is usually easy to tolerate but may occasionally cause diarrhea or stomach cramps. Unlike mineral oil, it doesn't interfere with the absorption of nutrients or vitamins.

Mineral oil is a liquid refined from crude oil. It lubricates the stool but doesn’t increase its water content like docusate. Mineral oil is colorless and odorless, and “baby oil” is a scented version of it. Mineral oil can interfere with your body’s absorption of fat-soluble vitamins like vitamin A, D, E, and K. This can eventually cause vitamin deficiency. Stool can also leak out from your rectum.

If you accidentally inhale mineral oil while trying to swallow, it can cause life-threatening lung irritation. Although mineral oil usually stays in your intestine, if you take both docusate and mineral oil together, the mineral oil may actually absorb into your body, away from where it can help relieve any painful elimination.

Emollients like docusate and mineral oil can turn your stool "mushy" but don’t directly stimulate the muscles lining your intestine. While most people get results within 2 days, it can take up to five days for full effect.

Here are 6 Tips on Using a Stool Softener for Constipation:

1.         Stay hydrated.

Drink enough fluids will help docusate do its job of moving water into your stool.

2.         Avoid docusate sodium if you are on a sodium-restricted diet.

Docusate has two forms, sodium, and calcium. If you are restricting your sodium intake, choose docusate calcium instead of docusate sodium. It can be hard to find. If you don’t see it on the shelf, ask the pharmacist.

3.         If you have trouble swallowing pills, avoid 250mg docusate capsules.

Although the 250mg capsule seems a better value than the 100mg because they often cost the same, the 250mg capsule is HUGE and should never be cut.

4.         Never cut or bite docusate capsules.

Docusate tastes HORRIBLE, just like soap, because that’s what it is. Avoid biting or cutting docusate capsules unless you like a strong, soapy flavor. The syrup tastes nearly as bad; it ranks consistently at the bottom of my liquid taste tests, and its aftertaste can linger for hours.

5.         For more reliable results, choose a laxative.

There isn’t much evidence that docusate prevents constipation. OTC laxatives like SenakotÆ and DulcolaxÆ are just as safe as docusate, and much more effective. Docusate is also available combined with a laxative like senna or bisacodyl in the OTC products Senakot-SÆ and Peri-ColaceÆ.

Dr. Louise Achey, Doctor of Pharmacy, is a 42-year veteran of pharmacology and author of Why Dogs Can’t Eat Chocolate: How Medicines Work and How YOU Can Take Them Safely. Get clear answers to your medication questions at her website and blog TheMedicationInsider.com.

2021 Louise Achey