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Things We Do for No Reason: Prescribing Docusate for Constipation

Constipation is a highly prevalent problem in all practice settings... One of the most commonly prescribed agents, regardless of medical specialty, is docusate, also known as dioctyl sulfosuccinate or by its brand name, Colace. Docusate is thought to act as a detergent to retain water in the stool, thereby acting as a stool softener to facilitate stool passage. Physicians have prescribed docusate for decades, and attendings have passed down the practice of prescribing docusate for constipation to medical trainees for generations. The initial docusate studies showed promise, as it softened the stool by increasing its water content and made it easier to pass through the intestines.

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Articles of Interest

Colace vs. Dulcolax: Differences, similarities, and which is better for you

Colace (docusate sodium) is an over-the-counter medication used to treat and relieve the symptoms of constipation. Colace acts as a surfactant and lowers the surface tension of oil and water in the stool. This allows lipids and moisture to penetrate the stool, producing a softer stool that can move more easily through the gastrointestinal tract. Colace is classified as a stool softener but is not considered a laxative because it does not directly stimulate motility.

Dulcolax vs Colace vs MiraLAX: Which Is Best for Constipation Relief?

When choosing between these options for constipation relief, consider how quickly you need it, whether you prefer a gentler approach, and your sensitivity to side effects. MiraLAX is great for soft, consistent relief. Dulcolax is ideal for fast action. Colace is best if you need to avoid straining.

How does Colace (docusate) work?

The mechanism of action of Colace is based on its surfactant properties, which lower the surface tension of the stool, making it easier to pass. This is in contrast to stimulant laxatives, which work by irritating luminal sensory nerve endings, thereby stimulating colonic motility and reducing colonic water absorption.

How Useful Is Docusate in Patients at Risk for Constipation? A Systematic Review of the Evidence in the Chronically Ill

This review reveals that treatment of constipation with docusate in chronically ill patients and terminally ill patients is based on inadequate experimental evidence. A rigorously designed, randomized, double-blind, controlled trial in a well-defined population measuring standardized and clinically relevant outcomes would be of great assistance in clarifying the effectiveness of docusate in the chronically ill.

Reevaluating the Use of Docusate in the Management of Constipation

Although the use of docusate remains common, evidence to support its use is based on a small number of clinical trials which often carried significant limitations. Pharmacists should be mindful of the lack of robust evidence to support the use of docusate for the management of constipation.

Stool softeners for constipation should be reconsidered, review suggests

The stool softener docusate is often a standing order for patients with constipation, such as those in the hospital or long-term care, said Dr. Janice Mann of the Canadian Agency for Drugs and Technologies (CADTH), an independent group funded by the federal and provincial governments to assess the effectiveness of medical interventions. "We didn’t find any evidence to say that they do work," Mann said.

Resources

Colace

Colace® Capsules contain docusate sodium, which allows water and fats to get into the stool, helping to soften and make passing it more comfortable.

StatPearls

Belonging to the stool softener class of drugs, it reduces the surface tension of the oil and water interface within the stool, facilitating the passage of water and lipids into the stool mass. The goal is for the stool to become softer and move through the intestinal tract more easily. Docusate has no indications approved by the U.S. Food and Drug Administration (FDA).