What Is A Stool Softener

  • Jialu Li Master of Science in Language Sciences (Neuroscience) UCL

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Introduction

Constipation is among one of the most prevalent clinical symptoms in our everyday life. Stool softeners which are a group of laxatives, are highly popular to be used in the cure of the condition. This article will give you a brief overview of how they work, what is their effectiveness and why they are popularly in use. 

Stool softeners are used to treat one of the most prevalent clinical conditions called constipation.1 They are within the group of laxatives which are the medications or substances used for the treatment of constipation.

Stool softeners initiate a mechanism which allows water into the stool and makes them softer. Subsequently, the smoothened stool moves through the bowel with ease of action.

Types of stool softeners 

Over-the-counter stool softeners

Over-the-counter stool softeners are sold at any drug store or chemist without the need for prescription.2 

As an example, docusate sodium is a highly accessible over-the-counter stool softener.3 The mechanism of action involves initiation of the small and large intestine by a detergent within the ingredients of the drug, subsequently, leading to fluid formation. The effectiveness of docusate is debatable, some studies have proposed its impact whereas some studies reported it does not show effective improvement in chronic constipation. 

Another example is enemas, which are well-known and highly accessible over-the-counter stool softeners. Their action is through triggering the water flow into the rectum. However, the use of enemas is risky since the misinsertion can potentially result in extreme injury to the lining of the rectum.3

Prescription stools softeners

When the constipation is severe or chronic or there are other health conditions underlying, there is a need to use stronger stool softeners. Those stool softeners are sold on prescription basis and monitored by healthcare professionals.2 For instance, Lubiprostone (Amitiza) is in use for the treatment of chronic idiopathic constipation.4 

How do stool softeners work?

The stool softeners do not have a prompt response.2 Rather, they have timely action which can take up to 72 hours to see their effects. The general mechanism of stool softeners is allowing water absorptions to moisturize the stool, subsequently, easing the movement of the stool inside of the bowel. Their moisturizer properties are linked to a substance they are made of, called surfactant. Different stool softeners can demonstrate variances in either allowing water into stool or water but the overall concept is the same. 

Impact on digestive system

Stool softeners are not assimilated into the bloodstream, therefore, they do not have frequent side effects. They do not have any direct impact on the muscles of the digestive tract which enhances their safety. Long-term use should be only adhered to by professionals. Meanwhile, the commonly observed list of rare side effects are as follows:2

  • Nausea
  • Stomach cramps
  • Bloating
  • throat irritation (with liquid stool softeners)

These signs of life-threatening side effects which require medical action:

  • Rash
  • Hives
  • Difficulty in breathing or swallowing
  • Fever
  • Vomiting
  • Stomach Pain

Conditions obligating stool softener usage

  • If you have haemorrhoids
  • During the course of recovery from anal fissure
  • After giving birth 
  • After surgery
  • After a heart attack
  • Living with a heart condition
  • Irritable Bowel Syndrome (IBS)

Proper usage and dosage of stool softeners

Stool softeners are either in a capsule or have a tablet shape.2 They are recommended to be taken before sleeping and advised to consume a lot of water throughout the day to boost the bowel movement. Some stool softeners such as Docusate, mentioned above, can be taken as an oral solution. Docusate is manufactured as 100 mg oral gels and dosages can be consumed as 50-100 mg or in some cases up to 300mg can be taken.

However, the proper management of the dose should be advised by the healthcare provider or the pharmacy. Moreover, long-term use of stool softeners should only be decided by the health care providers even if they do not have common serious side effects.

Interacting with other medicals

In the literature, the potential of stool softeners getting into interaction with other drugs, eventually, resulting in side effects have been mentioned. Mineral oil, which is a laxative and heals constipation, has an interactive nature with the stool softeners.5 Therefore, use of stool softeners with other medication should be strictly avoided unless recommended by a healthcare professional.

Lifestyle and dietary requirements

Stool softeners are not highly effective in the treatment of constipation. There is a need for supportive actions such as changing the lifestyle and dietary intake of your life. If you are suffering from constipation, aerobic exercises such as qigong, walking and physical movement may help you ease the symptoms and increase the bowel movement of the stool (6). Additionally, adjusting your diet and incorporating fluid, fibres, probiotics and dairy in your diet also assists your healing from constipation.7

Summary

To summarize, stool softeners are highly safe to use which makes them the top choice in the treatment of constipation. Especially, people who are post-partum, at an older age and living with a heart condition should strictly avoid straining. The non-interactive nature of the stool softeners with muscles and not having side effects allow usage by those people who require extra precautions. Nonetheless, the stool softeners do not have a strong action on constipation. Subsequently, diseases such as chronic constipation, and irresistible bowel syndrome require another treatment course by the health-care providers. Moreover, even if the side effects are not common, you should be aware of the possible outcomes and immediately seek help if anything arises. Last but not least, changing your habits and having a more active lifestyle by doing aerobic exercise as well as consuming fluid, fibre and dairy-containing meals will further help your constipation to heal.

  • Stool softeners are medical drugs used for the treatment of constipation.
  • Stool softeners either enhance water assimilation into stool or the bowel
  • Stool softeners help motility of the stool inside the bowel
  • Stool softeners are highly safe to use in pregnancy, postpartum and elderly populations. 
  • Stool softeners are highly available as over-the-counter medications
  • Prescription-based stool softeners require medical monitoring
  • The course of constipation should be finely monitored for seeking medical advice in severe cases
  • Serious illness-related constipation requires another treatment rather than stool softeners
  • Stool softeners do not have a strong effect on the treatment of constipation
  • For the optimisation of the stool softener effect, reinforcement of dietary intake and lifestyle is required

References

  • Rao SSC, Brenner DM. Efficacy and Safety of Over-the-Counter Therapies for Chronic Constipation. American Journal of Gastroenterology. 2021 Mar 17;Publish Ahead of Print.
  • Para R. Stool Softeners and Lubricants in Treatment of Chronic Constipation CHAPTER 6C Chapter · September 2023 CITATIONS 0 READS 123. 2023.
  • Portalatin M, Winstead N. Medical Management of Constipation. Clinics in Colon and Rectal Surgery [Internet]. 2012 Mar;25(01):012–9. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3348737/ 
  • Hayat M, Zia H, Nusrat S. Lubiprostone in the treatment of chronic idiopathic constipation: an update on health-related quality of life and patient-reported outcomes. Patient Related Outcome Measures. 2019 Feb;Volume 10:43–7.
  • Olshansky B, Chung MK, Budoff MJ, Philip S, Jiao L, Doyle RT, et al. Mineral oil: safety and use as placebo in REDUCE-IT and other clinical studies. European Heart Journal Supplements [Internet]. 2020 Oct 1;22(Supplement_J):J34–48. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7537802/ 
  • Gao R, Tao Y, Zhou C, Li J, Wang X, Chen L, et al. Exercise therapy in patients with constipation: a systematic review and meta-analysis of randomized controlled trials. Scandinavian Journal of Gastroenterology. 2019 Feb;54(2):169–77.
  • Bae SH. Diets for Constipation. Pediatric Gastroenterology, Hepatology & Nutrition [Internet]. 2014;17(4):203. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4291444/ 

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This content is purely informational and isn’t medical guidance. It shouldn’t replace professional medical counsel. Always consult your physician regarding treatment risks and benefits. See our editorial standards for more details.

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Selun Ilseven

Masters of Cancer Research and Precision Oncology- MSc, University of Glasgow, Scotland.

Selun, with a robust foundation in genetics, cancer research, and precision oncology, she combines her extensive scientific knowledge with years of expertise in science writing, communication, and managing scientific societies.

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