Occasional constipation is not uncommon. A little over 10% of adults experience symptoms of constipation during some time. And about one-third of adults 60 years or older report having symptoms of constipation. Healthcare professionals define constipation as having three or fewer bowel movements per week. Sometimes, the stool may be dry and hard.
In many cases, constipation can be managed at home with a combination of diet and physical activity changes and over-the-counter (OTC) treatments, such as stool softeners or laxatives. Stool softeners and laxatives are medications that help with bowel movements. Laxatives are divided into groups based on how they work. Stool softeners are a type of laxative.
This article will explain the key differences between stool softeners and laxatives. It will discuss when to take a stool softener versus a laxative, side effects, and precautions to watch out for with both.
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Understanding Laxatives
Many laxatives are available without a prescription as OTC products. They come in various forms, including:
- Oral tablets
- Oral capsules
- Oral liquids
- Powders for mixing in liquids
- Rectal suppositories
- Rectal enemas
Laxatives work in different ways to help you have a bowel movement. They are grouped into the following categories based on how they work:
- Bulk-forming laxatives: These laxatives contain fiber, adding weight to your stool and stimulating bowel movement. Examples include Metamucil (psyllium) and Citrucel (methylcellulose).
- Stimulant laxatives: These laxatives stimulate the muscles along your intestines, causing them to contract and move stool along your colon (large intestine). Examples include Senokot (senna) and Dulcolax (bisacodyl). Senna can be crushed and added to beverages or foods, while bisacodyl cannot be crushed and consumed because it will lead to stomach irritation.
- Osmotic laxatives: Osmotic laxatives draw water into your large intestine to make your stool looser. Examples of these types of laxatives include Miralax (polyethylene glycol 3350) and Citroma (magnesium citrate).
- Stool softeners: Stool softeners increase the amount of water and fat your stool absorbs. This makes the stool softer and makes its movement through your colon easier.
Understanding Stool Softeners
As mentioned above, stool softeners are a type of laxative. Sometimes, they're called emollient laxatives. This is because they help relieve constipation by increasing the amount of water and fat your stool absorbs. This makes the stool softer and easier to move.
Most stool softeners contain the active ingredient docusate. Examples of OTC stool softeners with docusate include:
- Colace
- Diocto
- Phillips' Stool Softener
- Surfak
Dosing
Laxatives and stool softeners are typically for managing occasional constipation. Sometimes, healthcare providers may recommend a laxative or stool softener to help prevent constipation. Some people have used laxatives for weight loss. However, stool softeners and laxatives are not approved for this use and should not be taken as such.
Misuse of laxatives for weight loss can result in serious side effects. For example, misusing laxatives can cause an imbalance of essential minerals and electrolytes, such as sodium, phosphorus, and potassium. Your body needs the proper levels of these substances for the healthy functioning of your heart, gut, muscles, and other organs.
Also, misuse of laxatives may lead to dehydration. If dehydration becomes severe or is left untreated, it can result in serious complications, such as brain damage, seizures, and even death. It's important to use laxatives or stool softeners according to your healthcare provider's instructions or the instructions on the medication's packaging.
The following are general dosing recommendations for common OTC laxatives and stool softeners.
Laxatives
Dosing for laxatives can depend on the type of laxative you use.
Bulk-Forming Laxatives
The bulk-forming laxative Metamucil is typically taken one to three times per day. Citrucel may be taken up to six times daily, depending on the form you use.
With Metamucil and Citrucel, you usually start with a lower dosage to allow your body to get used to the extra fiber. You may gradually increase how often you take this laxative daily if necessary. Citrucel is available as an oral tablet and a powder that you dissolve in water or other liquid to drink. Metamucil is available as capsules and wafers that you take by mouth. It's also available as a powder that you mix with water or other liquid for drinking.
If you take Metamucil or Citrucel powder, mix one dose with 8 ounces (240 milliliters) of water or other liquid. Other oral forms of these medications should also be taken with at least 8 ounces of water or other liquid. Knowing that Metamucil may only work well with enough water or liquid is important. Citrucel may cause choking if it's not taken with enough water or liquid.
Stimulant Laxatives
Senokot and Dulcolax are examples of common stimulant laxatives. The recommended dosage of Senokot is one to four tablets once or twice daily, while Dulcolax tablets are typically taken once daily. Senokot and Dulcolax usually produce a bowel movement about six to 12 hours after a dose. Some people find taking a dose at bedtime to have a bowel movement the following day helpful.
Osmotic Laxatives
Miralax, an osmotic laxative, is a powder you mix in water or another liquid and drink. Citroma does not need to be mixed before drinking. It's available as a ready-to-drink liquid.
The recommended dosage for Miralax is 17 grams mixed in 4 to 8 ounces of any beverage taken once per day until you have a bowel movement. Having a bowel movement may take two to four days with Miralax. Do not take Miralax for more than seven days in a row. If you've taken Miralax for seven days and haven't had a bowel movement, contact your healthcare provider.
Citroma doses may be taken as a single daily dose or divided throughout the day. The recommended dosage for adults is 6.5 to 10 milliliters (mL) per 24 hours. As with bulk-forming laxatives, you should drink at least 8 ounces of liquid with each Citroma dose.
Stool Softeners
Stool softeners are available as oral tablets, capsules, and liquids that you take once per day. Stool softeners, such as Colace and Diocto, are typically taken once per day at bedtime. These laxatives work best when you take them regularly for up to three days. Take the tablets and capsules with a full glass of water.
Stool Softeners vs. Laxatives: Which One Works Best?
If you have symptoms of constipation, you may want to know when to use a stool softener versus a laxative. Your choice between stool softeners and laxatives may depend on the severity of your constipation and how long the medication takes to work.
Stool softeners help make your stool softer and easier to pass. Because of this, they may be a good choice if a healthcare provider has recommended you avoid straining while having a bowel movement. This may be the case if you have certain heart conditions, hemorrhoids, or have recently had major surgery. Stool softeners can also help if your stool is dry and hard.
However, stool softeners may take a few days to start working. Stimulant laxatives, on the other hand, work much faster. Oral laxatives, such as Dulcolax and Senokot, can work as quickly as a few hours. And rectal suppositories can produce a bowel movement in a matter of minutes.
Stimulant laxatives may be a good choice for fast relief of occasional constipation. However, they are not considered safe for long-term use. Bulk-forming laxatives work slowly and gently. These laxatives are often used daily to promote regular bowel movements and prevent constipation.
Side Effects
Side effects of stool softeners and laxatives are generally mild when these medications are taken at recommended dosages. However, taking higher doses or misusing laxatives can result in more serious side effects.
Laxatives
Mild side effects of laxatives can include:
- Abdominal pain or cramping
- Upset stomach
- Nausea
- Mild diarrhea
- Gas
- Skin rash
- Itching
- Dizziness
- Brown-colored urine
In rare cases, laxatives may cause serious side effects, such as:
- Trouble swallowing
- Choking
- Vomiting
- Severe diarrhea
- Blood in the stool
- Dehydration
Stool Softeners
Mild side effects of stool softeners include:
- Abdominal cramping
- Nausea
- Throat irritation (with the liquid form)
Rarely, stool softeners may cause more serious side effects, including:
- Vomiting
- Trouble swallowing
- Hives
- Fever
- Severe stomach pain
Tell your healthcare professional immediately if you have serious side effects while taking any laxative or stool softener. Also, talk with your provider if you have bothersome side effects that last more than a few days.
Who Should Avoid Stool Softeners and Laxatives?
Stool softeners and laxatives may not be for everyone. They may negatively affect certain health conditions.
Before taking a laxative or stool softener, let your pharmacist or other healthcare provider know if you:
- Are pregnant or breastfeeding
- Are 65 years of age or older
- Have ever had an eating disorder
- Have diabetes or are on a low-sugar diet
- Have a kidney condition
- Have heart disease
- Have high blood pressure
- Have trouble swallowing
- Have you ever had a blockage in your intestines
- Have rectal bleeding
Having any of these conditions doesn't mean you should not take any stool softener or laxative. In many cases, certain stool softeners or laxatives are not safe to use with certain health conditions. However, often, there are safer alternatives.
Certain laxatives can also interact negatively with some medications. Talk with your healthcare provider before taking stool softeners or laxatives if you take:
- Mineral oil
- Lanoxin (digoxin)
- Salicylates, such as aspirin
- Macrobid (nitrofurantoin)
- Antacids, such as Milk of Magnesia (magnesium hydroxide)
Talking with your healthcare provider about your health history is important. They can help you determine which stool softener or laxative is safe based on your health conditions or medications.
Alternative Treatments
In addition to stool softeners and laxatives, there are several steps you can take to manage and even prevent constipation.
- Adding fiber to your diet: Eating more fiber-rich foods can help add weight to your stool and prevent constipation. Examples of foods that are good sources of fiber include whole grains, such as brown rice, quinoa, and oatmeal. Other fiber-rich foods include nuts, apples, and beans.
- Increasing your water intake: Getting enough water throughout the day is essential for many laxatives to work well. Increased water intake also helps keep your stool soft and makes its movement through your colon easier.
- Getting regular exercise: Moving your body helps to move your digestive tract. Regular exercise increases blood flow to your intestines and helps stool move through your bowels more quickly.
Summary
OTC stool softeners and laxatives are commonly taken to relieve symptoms of occasional constipation. Stool softeners are a type of laxative. Other types of laxatives include bulk-forming laxatives, stimulant laxatives, and osmotic laxatives. Stool softeners and bulk-forming laxatives work gently and slowly. Stimulant laxatives typically work faster.
It's important to take laxatives or stool softeners according to your healthcare provider's instructions. Taking laxatives for longer than recommended or at higher doses can lead to serious side effects, including electrolyte imbalance and dehydration. Before taking OTC laxatives or stool softeners, talk with your pharmacist or healthcare provider about your health history and the medications you take. Certain medications and health conditions can interact negatively with them.
