What is a stool softener?
A stool softener is a type of laxative that helps soften stool and allow for easier passage. Stool softeners work by drawing water into the stool from the intestines, making the stool softer and easier to pass. Common active ingredients in stool softeners include docusate sodium, docusate calcium, and docusate potassium.
Stool softeners are generally considered safe when used as directed. However, taking too much can lead to diarrhea or electrolyte imbalances. This article will discuss how stool softeners work, provide dosage guidelines, and outline signs of taking too much.
How do stool softeners work?
Stool softeners work by allowing more water to penetrate and soften the stool. There are a few ways they accomplish this:
- Surfactant action: Some stool softeners like docusate sodium work as surfactants. Surfactants reduce surface tension and allow water to better penetrate and interact with stool.
- Stimulating intestinal fluid secretion: Stool softeners may stimulate secretion of fluid from the intestinal wall into the stool.
- Limiting water reabsorption: Stool softeners may limit the amount of water reabsorbed from the stool as it passes through the intestines.
The end result of these actions is a softer, easier to pass stool. Stool softeners do not stimulate bowel contractions like some other types of laxatives. They simply allow the stool to retain more moisture, making it easier to pass.
What is the recommended dosage for stool softeners?
Here are general dosage guidelines for some common stool softeners:
Docusate sodium
- Adults: 50-300 mg daily in 1-4 divided doses
- Children 6-11 years: 50 mg daily in 1-4 divided doses
- Children 2-5 years: 25 mg daily in 1-4 divided doses
Docusate calcium
- Adults: 240 mg daily in 1-4 divided doses
- Children 6-11 years: 120 mg daily in 1-4 divided doses
- Children 2-5 years: 60 mg daily in 1-4 divided doses
Docusate potassium
- Adults: 100-300 mg daily in 1-4 divided doses
- Children 6-11 years: 50-150 mg daily in 1-4 divided doses
- Children 2-5 years: 25-75 mg daily in 1-4 divided doses
These dosages may be exceeded slightly if stool remains hard and difficult to pass. However, it’s generally best to stay within recommended guidelines. Always speak with your pharmacist or doctor about appropriate dosing, especially for young children.
Signs of too much stool softener
Taking more than the recommended amount of stool softeners can lead to side effects like:
- Diarrhea – Frequent, loose, watery stools. This is one of the most common side effects of too much stool softener.
- Electrolyte imbalances – Taking too much stool softener can cause you to lose too much water from diarrhea, leading to dehydration and electrolyte disturbances.
- Abdominal cramps – Some people may experience cramping from taking excessive amounts of stool softeners.
- Nausea – The gastrointestinal disturbances from overusing stool softeners can lead to nausea.
- Rectal leakage – Very loose stools from taking too much softener may be difficult to control, leading to leakage.
Diarrhea is the most common symptom and sign that too much stool softener is being taken. More than 2-3 loose stools per day may indicate overuse. Severe diarrhea can lead to dehydration, which is particularly dangerous in vulnerable populations like older adults and young children.
If diarrhea persists for more than 2-3 days, the stool softener dosage should be reduced or stopped. Electrolytes levels may need monitoring in some cases of severe diarrhea. Immediately contact your doctor if you experience signs of dehydration like excessive thirst, dry mouth, dizziness, or dark urine.
How much is too much?
It’s difficult to define a specific amount of stool softener that is too much, since appropriate dosing can vary based on factors like:
- Age
- Underlying health conditions
- Other medications being taken
- Stool softener formulation (capsule, liquid, etc)
Exceeding the maximum recommended dose for your age group would be considered too much. As a general guideline:
- Adults should not exceed 300 mg per day of docusate sodium or potassium formulas.
- Older adults are often advised to start at lower doses like 50-100 mg daily.
- Children should not exceed the maximum daily dose for their age range.
Taking more than the maximum recommended amount puts you at risk for side effects like diarrhea. It’s also unnecessary – stool softeners work through mild, gradual effects. Excessive use does not provide increased benefits.
The key is to use the lowest dose that provides relief. If you need to use stool softeners daily, try reducing the dose to the minimum effective amount. Periodically re-evaluate whether an ongoing need exists. As a general guideline, avoid exceeding recommended maximum doses.
Who is at risk for complications?
Certain populations have an increased risk of side effects from taking too much stool softener:
Older adults
Older adults are more susceptible to dehydration and electrolyte disturbances. Their kidneys may not be able to compensate as well for fluid/electrolyte shifts. Older adults also commonly take multiple medications, increasing the risk of interactions with stool softeners.
Young children
Too much stool softener can lead to significant diarrhea and dehydration in young kids. Their smaller body size means they are impacted more than adults by an excessive dose.
Those with kidney disease
Individuals with chronic kidney disease or acute kidney injury may not be able to regulate fluid and electrolyte balance as well. Taking too much softener increases dehydration and electrolyte complication risks.
People taking diuretics
Diuretic medications can have additive effects with stool softeners, increasing the risk of dehydration and electrolyte issues. Combining the two drugs warrants caution.
Those with inflammatory bowel disease
People with ulcerative colitis, Crohn’s disease or other inflammatory bowel diseases may be more sensitive to stool softeners and at increased risk of diarrhea or cramping with higher doses.
If you fall into one of these vulnerable groups, have a discussion with your doctor about ideal stool softener dosage and safety precautions. In general, it’s wise to start with lower doses and increase gradually only if needed.
Are dependency and abuse risks?
Stool softeners do not have significant abuse potential, but some dependency can develop with long-term use.
Some key points:
- Stool softeners are not addictive and do not cause euphoria or intoxication like drugs of abuse.
- However, the bowels can grow dependent on stool softeners after weeks to months of continued use.
- When stopped suddenly after long-term use, constipation and harder stools may result.
- Dependence can often be avoided by periodically stopping use for a few days to allow normal bowel function to recur.
- Gradually tapering the dosage down over several days can also help prevent dependency.
While not completely risk-free, stool softeners have a relatively low risk of dependence with judicious use. Avoid exceeding dosage guidelines and long-term daily use without breaks. Discuss any difficulty stopping with your doctor.
Are there alternatives to stool softeners?
Several natural remedies and lifestyle approaches may help keep stool soft without using stool softeners:
Dietary modifications
- Drink plenty of fluids like water and prune juice
- Eat high-fiber foods such as fruits, vegetables, whole grains
- Incorporate probiotic foods like yogurt into your diet
Exercise
Regular physical activity stimulates the bowels and can aid defecation.
Herbal remedies
Gentle herbal laxatives like senna, cascara or flaxseed may promote bowel regularity. Always check with your doctor before using herbal products.
Abdominal massage
Massaging the abdomen in a clockwise direction can help stimulate bowel activity.
Squatting position
Elevating the feet with a stepstool while sitting on the toilet can align the body in a squatting position that may make defecation easier.
Lifestyle modifications are recommended as first-line approaches for mild constipation. However, people with problematic chronic constipation may still require judicious use of stool softeners. Work with your doctor to find the right balance.
Conclusion
Stool softeners are generally safe when used as directed, but taking too much can lead to diarrhea, dehydration and other complications. Adhering to recommended dosing guidelines based on your age and avoiding excessive duration of use are keys to safety. Older adults, young children, and those with medical conditions need extra precautions with stool softener use. Lifestyle approaches may reduce the need for stool softeners in some cases of mild constipation.