From the Guidelines
Stool softeners, such as docusate, are considered safe to use during pregnancy when needed for constipation relief. The most recent and highest quality study, published in 2024 in the journal Gastroenterology 1, provides guidance on the management of constipation in pregnant individuals. According to this study, constipation in pregnant persons may result from hormonal, medication-related, and physiological changes, and treatment options include dietary fiber, lactulose, and polyethylene glycol–based laxatives.
Key Points to Consider
- Before turning to medication, increasing water intake to at least 8-10 glasses daily, consuming more fiber-rich foods like fruits, vegetables, and whole grains, and maintaining regular physical activity as approved by your healthcare provider can help alleviate constipation.
- Bulk-forming agents, such as psyllium husk or methylcellulose, are safe to administer in pregnancy because of the lack of systemic absorption, as noted in the study 1.
- Osmotic laxatives, such as polyethylene glycol or lactulose, can also be administered safely during pregnancy, but stimulant laxatives should be avoided due to conflicting safety data.
- It is essential to consult with your healthcare provider before taking any medication during pregnancy to ensure it's appropriate for your specific situation, as emphasized in the study 1.
Recommendations
- Typical dosing for docusate sodium (Colace) is 100 mg once or twice daily, though you should not exceed the recommended dosage on the package.
- If constipation persists despite using stool softeners for more than two weeks, or if you experience severe abdominal pain or rectal bleeding, contact your healthcare provider promptly.
- The study 1 highlights the importance of a detailed history taking regarding the frequency and consistency of bowel movements, presence of pain or bleeding during bowel movements, and severity of symptoms to evaluate constipation in pregnant individuals.
From the Research
Safety of Stool Softeners in Pregnancy
- Stool softeners, such as docusate, are considered safe to use during pregnancy, according to various studies 2, 3, 4.
- A study published in the Zeitschrift fur Geburtshilfe und Neonatologie in 2016 found that docusate sodium, a stool softener, seems to be safe regarding teratogenicity and lactation 2.
- Another study published in the Canadian family physician Medecin de famille canadien in 2008 recommended the use of stool softeners as a treatment for hemorrhoids in pregnancy, as they are unlikely to harm the fetus 3.
- A 2012 study published in the Canadian family physician Medecin de famille canadien also suggested that stool softeners are safe to use during pregnancy, as they have minimal systemic absorption and are not expected to be associated with an increased risk of congenital anomalies 4.
Comparison with Other Laxatives
- A 2015 review published in The Cochrane database of systematic reviews found that there is insufficient evidence to comprehensively assess the effectiveness and safety of interventions, including stool softeners, for treating constipation in pregnancy 5.
- The review found that stimulant laxatives appear to be more effective in improving constipation, but are accompanied by an increase in diarrhea and abdominal discomfort, while fibre supplementation may increase the frequency of stools 5.
- However, there were no data available for a comparison of other types of interventions, such as osmotic laxatives, stool softeners, lubricant laxatives, and enemas and suppositories 5.
Recommendations
- The American College of Gastroenterology's Committee on FDA related matters and the Motherisk Programme provide alternative solutions to improve decision-making regarding the use of laxatives during pregnancy 2.
- Healthcare providers should consider the benefits and risks of using stool softeners and other laxatives during pregnancy, and consult with patients to determine the best course of treatment 2, 3, 4.