From the Guidelines
Stool softeners like Colace (docusate sodium) generally do not cause physical dependence or laxative dependence when used as directed. Unlike stimulant laxatives that can potentially lead to dependence with long-term use, stool softeners work by increasing water content in the stool rather than stimulating bowel contractions. Colace is considered safe for longer-term use when needed, as it works by decreasing surface tension of stool to allow water to penetrate more easily 1. However, it's still best to address the underlying causes of constipation through lifestyle modifications such as:
- Increasing fiber intake (25-30g daily)
- Staying well-hydrated (6-8 glasses of water daily)
- Regular physical activity
- Establishing consistent bathroom habits If constipation persists beyond two weeks while using stool softeners, or if you need to use them regularly, consult a healthcare provider to rule out underlying conditions. The typical recommended dose for adults is 100-300mg of docusate sodium daily, divided into one or two doses, but this should be individualized based on your specific needs 1.
According to the American Gastroenterological Association Institute technical review on the medical management of opioid-induced constipation, there is limited direct evidence on the efficacy of laxatives in OIC, but indirect evidence suggests that laxatives, especially osmotic laxatives such as polyethylene glycol (PEG)-3350, can be beneficial in promoting laxation 1.
It's worth noting that the use of stool softeners like docusate sodium in palliative care is based on inadequate experimental evidence, and other laxatives like PEG or lactulose may be preferred in advanced disease 1.
In summary, while stool softeners like Colace are generally safe and do not cause dependence, it's essential to address the underlying causes of constipation and consider other treatment options, especially in patients with opioid-induced constipation or advanced disease.
From the Research
Dependence on Stool Softeners
- The use of stool softeners like docusate can lead to dependence, as patients may rely on them to have a bowel movement 2, 3.
- Studies have shown that docusate is frequently prescribed to medical inpatients despite its known ineffectiveness, with low deprescription and high numbers of new prescriptions 2.
- In older adults, docusate has been found to be no more effective than placebo in treating constipation, and other laxatives like psyllium and sennosides have been shown to be more effective 3.
Alternative Laxatives
- Polyethylene glycol (PEG) has been found to be an effective and safe laxative for the treatment of functional constipation, with good evidence to recommend its use as a first-line laxative 4, 5.
- Senna has also been found to be an effective laxative, with good evidence to recommend its use as a first-line laxative 6, 5.
- Other laxatives like psyllium, magnesium salts, and stimulants like bisacodyl and sodium picosulfate have been found to be effective, but with moderate evidence 5.
Risks of Dependence
- The use of stool softeners like docusate can lead to dependence, as patients may rely on them to have a bowel movement, rather than addressing the underlying cause of their constipation 2, 3.
- Dependence on stool softeners can also lead to polypharmacy, as patients may be prescribed multiple medications to manage their constipation, increasing the risk of adverse interactions and side effects 2.