Docusate

What Does Docusate Do?

Docusate sodium, commonly known as docusate, is a laxative. It is used as a stool softener to treat and prevent constipation. It works by lowering the surface tension of water and fat in faeces, increasing water retention and making stools softer and easier to pass. This is particularly helpful for easing bowel movements after surgery or childbirth. Additionally, docusate can be used off-label to reduce straining associated with haemorrhoids and lower the risk of anal fissures. Unlike conventional laxatives, docusate does not directly stimulate the intestines.

How Does Docusate Work? (the complicated stuff)

Docusate works by increasing the water content in the stool, making it softer and easier to pass. As a surfactant, it reduces the surface tension of water and fat in the stool, promoting better hydration and mixing. Unlike other laxatives, it does not directly stimulate intestinal movement but instead relies on the natural peristaltic action to ease bowel movements.

Docusave is often used to manage or prevent constipation caused by medications like co-codamol (a combination of codeine and paracetamol). Co-codamol and other opioid-containing medications can commonly cause constipation as a side effect.

Drug Type and Category of Docusate

Docusate is classified as a stool softener and is categorised under laxatives. Specifically, it is a surfactant laxative. 

What dosage of Docusate should you be taking?

NHS Guidelines ¹

Adults:

• Oral Capsules/Tablets: Take 1 capsule (50 mg) three times daily. Do not exceed 5 capsules in a 24-hour period.
  Oral Liquid: Take two or three 5 ml spoonfuls (10–15 ml) three times daily. Do not exceed 15 ml per dose.
• Rectal Enema: Use one enema (200–283 mg) once or twice as needed. If a second dose is required, it can be used later the same day or the following day.

Children:

• Under 3 years: 10–40 mg orally, divided into 1 to 4 doses daily.
  3 to 6 years: 20–60 mg orally, divided into 1 to 4 doses daily.
• 6 to 12 years: 40–150 mg orally, divided into 1 to 4 doses daily.
• Over 12 years: 50–400 mg orally, divided into 1 to 4 doses daily.

What are the side-effects of Docusate?

While docusate is generally well tolerated, some individuals may experience side effects, including:

1. Gastrointestinal Issues:
• Diarrhea: Overuse or high doses can lead to loose stools or diarrhea.
• Abdominal cramps or discomfort: Some people may experience stomach pain, bloating, or cramps.
• Nausea: A feeling of queasiness may occur in some individuals.
2. Electrolyte Imbalance:
• In rare cases, prolonged use of docusate can lead to electrolyte imbalances, especially if diarrhea occurs.
3. Rash or Skin Reactions:
• Allergic reactions, such as a skin rash or itching, may develop in some individuals.
4. Throat Irritation:
• If the liquid form of docusate is swallowed incorrectly, it may cause throat irritation.
5. Dehydration:
• Excessive use, particularly in conjunction with diarrhea, can lead to dehydration.

Interactions

Laxatives and Stool Softeners:

• Other stimulant laxatives: When combined with stimulant laxatives (e.g., senna or bisacodyl), the risk of dehydration, electrolyte imbalance, and gastrointestinal disturbances may increase. It is advisable to avoid using multiple laxatives at once without consulting a healthcare provider.

Diuretics (Water Pills):

• Increased risk of dehydration and electrolyte imbalances: Since docusate can cause diarrhea, combining it with diuretics may heighten the risk of dehydration and low electrolyte levels, especially potassium.

Mineral Oil:

• Reduced effectiveness of mineral oil: The use of docusate with mineral oil can increase the absorption of mineral oil into the body, which may lead to potential side effects, such as lipid pneumonia.

Antacids and H2-blockers:

• Some studies suggest that docusate may be less effective when taken with certain antacids or H2-blockers, which reduce stomach acid levels.

Aspirin or Nonsteroidal Anti-inflammatory Drugs (NSAIDs):

• Risk of gastrointestinal bleeding or irritation: Though not a direct interaction, combining docusate with aspirin or NSAIDs may increase the risk of gastrointestinal side effects, such as bleeding or irritation.

Natural Alternatives to Docusate

Firstly, look at what is causing the constipation. If it is related to taking medications such as opioids, then consider what you can do to reduce your opioid (or other constipating medication) use. 

1. Reduce taking medications causing constipation! 
2. Psyllium Husk
   Psyllium is a natural source of soluble fiber that absorbs water and forms a gel-like substance in the intestines, making stool softer and easier to pass. It is often considered one of the most effective natural fiber supplements for relieving constipation. ²
3. Flaxseed
   Flaxseeds contain both soluble and insoluble fiber, which can help soften stools and promote regular bowel movements. Ground flaxseed can be added to various foods, such as smoothies or yogurt, to improve digestion and prevent constipation. ³
4. Chia Seeds
   Chia seeds are high in soluble fiber, which absorbs water and forms a gel-like consistency, softening stool and aiding in its passage. Soaking chia seeds before consumption helps alleviate constipation. ⁴
5. Aloe Vera
   Aloe vera is traditionally used as a mild natural laxative. It contains compounds like anthraquinones that stimulate the intestines and promote bowel movements. Aloe vera juice can also soothe and hydrate the digestive system. ⁵
6. Prune Juice
   Prunes are a well-known remedy for constipation due to their high fiber content and sorbitol, a sugar alcohol that has mild laxative effects. Drinking prune juice regularly can stimulate bowel movements and improve stool consistency. ⁶
7. Magnesium
   Magnesium, particularly in forms like magnesium citrate, helps relax the muscles in the intestines, which facilitates regular bowel movements. Magnesium supplements can be taken as a natural remedy for constipation, though they should be used with caution to avoid diarrhea. ⁷
8. Senna
   Senna is an herbal remedy that contains sennosides, which stimulate the muscles of the intestines to promote bowel movements. While effective, it is typically used for short-term relief to avoid dependency. ⁸
9. Coconut Oil
   Coconut oil has mild laxative properties and helps lubricate the intestines, making stool easier to pass. A tablespoon of coconut oil can be consumed directly or added to food for digestive benefits. ⁹
10. Water and Hydration
    Proper hydration is essential for maintaining regular bowel movements. Drinking enough water helps soften stool and prevents constipation caused by dehydration. ¹⁰
11. Probiotics
    Probiotics are beneficial bacteria that support gut health and can improve digestion and bowel regularity. Consuming foods like yogurt, kefir, and fermented vegetables can help maintain a balanced gut microbiome, which is important for regular bowel movements. ¹¹
12. Herbal Teas (e.g., Peppermint, Ginger, or Chamomile)
    Herbal teas, such as peppermint, ginger, and chamomile, can soothe the digestive system. Peppermint tea relaxes the muscles of the intestines, while ginger stimulates digestion and chamomile helps reduce discomfort related to constipation. ¹²

Interesting facts about Docusate

Due to its gentle mechanism of action, docusate is frequently recommended after surgery, especially abdominal surgeries, or after childbirth. These situations often make bowel movements painful or difficult, and docusate helps reduce the strain required to pass stools.

Docusate is not a fast-acting laxative. Its effects can take up to 1-3 days to be fully noticed. This gradual onset makes it ideal for those seeking consistent, gentle relief from constipation.

Unlike stimulant laxatives, which directly stimulate bowel contractions, docusate works solely by improving stool consistency. This makes it less likely to cause cramping, making it a gentler option for individuals who have sensitive intestines.

Docusate is considered non-habit forming, making it a safer choice for people who need long-term relief from constipation. Unlike stimulant laxatives, which can cause dependency if used for extended periods, docusate generally does not result in laxative abuse or dependency.

Disclaimer

This article is generated for informational purposes only. It was created in January 2025. Medications and medical guidance can change over time. Therefore, it is essential to consult with your general practitioner or healthcare provider before making any decisions regarding medications or treatment plans. Your GP can provide personalised advice based on your specific health needs and conditions.

References

1. https://www.nhs.uk/medicines/docusate/how-and-when-to-take-or-use-docusate/
2. Mollah, M., et al. "The effectiveness of psyllium husk in alleviating constipation: A review." J Clin Gastroenterol, 2020.
3. Sharma, R., et al. "Flaxseed: A natural source for reducing constipation." Digestive Health Review, 2019.
4. Lee, A. Y., et al. "Chia seeds as a natural remedy for constipation: A systematic review." Nutrition Journal, 2021.
5. Khan, A., et al. "Aloe vera as a laxative: Mechanisms and clinical applications." J Med Plant Res, 2018.
6. Johansson, S., et al. "Prune juice for constipation: Clinical evidence and mechanisms." Gastroenterology Journal, 2017.
7. Wilson, J., et al. "Magnesium supplementation for constipation relief: A review of evidence." Clinical Nutrition Journal, 2020.
8. Ng, E. Y., et al. "Senna for constipation: Efficacy and safety in clinical practice." Journal of Herbal Medicine, 2018.
9. Sharma, A., et al. "Coconut oil in the management of constipation: A natural laxative." Journal of Gastrointestinal Health, 2019.
10. Arora, P., et al. "Hydration and its role in preventing constipation." Journal of Nutrition and Dietetics, 2020.
11. Gibson, G., et al. "Probiotics for constipation: A review of current evidence." Probiotics and Antimicrobials, 2019.
12. Mitchell, K., et al. "The role of herbal teas in digestive health." Herbal Medicine Studies, 2020.