Docusate: a laxative to treat constipation

1. About docusate

Docusate is a type of medicine called a laxative. It helps to soften your poo and makes your bowel movements easier if you have problems pooing (constipation).

It is helpful when you have difficulty going to the toilet because of dry poos or piles (haemorrhoids) or if you have a tear in the lining of your intestine near your anus (anal fissure).

You may also be given docusate if you’re going to have an x-ray of your stomach. It can help you empty your bowels beforehand.

Docusate comes as capsules and as a liquid that you swallow. It also comes as an enema. This is a tube of liquid medicine which you squeeze into your anus (bottom).

Docusate is available on prescription or to buy from pharmacies. There is one brand called DulcoEase that you can buy in pharmacies and shops.

2. Key facts

• Docusate capsules and liquid take 1 or 2 days to work.
• The enema usually works within 20 minutes, so it’s best to stay close to a toilet.
• Only give docusate to a child under 12 years old if their doctor prescribes it.
• Do not take it for more than a week without talking with your doctor.
• Common side effects include feeling sick (nausea).

3. Who can and cannot take docusate

Most adults and children aged 12 years and over can safely take docusate.

Important

Never give docusate to a child under 12 years old unless their doctor prescribes it.

Docusate is not suitable for some people. To make sure it is safe for you, tell your doctor or pharmacist if you have:

• ever had an allergic reaction to docusate or any other medicines
• a blockage in your gut (intestine)
• stomach pains
• been feeling sick or have vomited in the last 24 hours

Do not use an enema containing docusate if you have:

• piles (haemorrhoids) or bleeding from your bottom
• a sore around your anus (anal fissure)
• ulcerative colitis or Crohn’s disease, or other inflammatory bowel condition
• parlytic ileus (when the muscles in your bowel are not able to move food and liquid along)

4.

How and when to take or use docusate

Docusate comes as capsules, liquid and an enema.

How to take or use it

Capsules – swallow the capsule whole with plenty of water.

Liquid – this comes with a plastic cup or spoon to measure the dose. Do not use a kitchen spoon as it will not give the right amount. If you do not have a cup or spoon, ask your pharmacist for one. When you’ve swallowed it, drink plenty of water or have another drink, such as milk or orange juice.

Enema – squeeze the tube of liquid gently into your anus. The information leaflet which comes with your docusate will explain how to do this.

Docusate does not usually upset your stomach. You can take the capsules or liquid with or without food. Try to take your medicine at regular intervals throughout the day. Mealtimes (breakfast, lunch and dinner) are useful reminders.

There is no specific time of day to use an enema but it works quickly (usually between 5 and 20 minutes), so use it when you know you’ll be near a toilet.

Dosage

Capsules – the normal dose is 1 capsule, taken 3 times a day. Do not take more than 5 capsules in a day.

Liquid – the normal dose is two or three 5ml spoonfuls. Take this dose 3 times a day.

Enema – normally 1 tube of liquid is all you need. If you need a second dose, you can use it later in the day or the next day.

You will usually feel more comfortable within 1 or 2 days of treatment. Reduce the dose as your condition gets better.

Drink plenty of fluids (6 to 8 glasses a day) while you are taking docusate or your constipation may get worse.

What if I forget to take it?

If you forget a dose of docusate, do not worry. Just take the next dose as normal.

Never take 2 doses at the same time. Never take an extra dose to make up for a forgotten one.

What if I take too much?

Taking an extra dose of docusate as a one-off is unlikely to harm you, but it is a good idea to drink lots of water. You may get diarrhoea and stomach pain, but this will usually get better within 1 or 2 days.

If you’re worried, talk to your doctor or a pharmacist for advice.

5. Side effects

Like all medicines, docusate may cause side effects in some people but most people have no side effects or only minor ones.

Common side effects

If you get any of these side effects, talk to your doctor or pharmacist:

• feeling sick (nausea)
• diarrhoea
• stomach cramps

These side effects are mild and usually go away after a couple of days.

When using a docusate enema you may get a burning feeling or pain around your bottom (anus). Occasionally the wall of the anus may bleed. This is a reaction to the enema and it usually clears up quickly. If the pain or bleeding does not go away or you are worried, talk to your doctor or pharmacist.

Serious side effects

In rare cases, it’s possible to have a serious allergic reaction (anaphylaxis) to docusate.

Immediate action required: Call 999 now if:

• your lips, mouth, throat or tongue suddenly become swollen
• you’re breathing very fast or struggling to breathe (you may become very wheezy or feel like you’re choking or gasping for air)
• your throat feels tight or you’re struggling to swallow
• your skin, tongue or lips turn blue, grey or pale (if you have black or brown skin, this may be easier to see on the palms of your hands or soles of your feet)
• you suddenly become very confused, drowsy or dizzy
• someone faints and cannot be woken up
• a child is limp, floppy or not responding like they normally do (their head may fall to the side, backwards or forwards, or they may find it difficult to lift their head or focus on your face)

You or the person who’s unwell may also have a rash that’s swollen, raised, itchy, blistered or peeling.

These can be signs of a serious allergic reaction and may need immediate treatment in hospital.

These are not all the side effects of docusate. For a full list see the leaflet inside your medicines packet.

Information:

You can report any suspected side effect using the Yellow Card safety scheme.

Visit Yellow Card for further information.

6. How to cope with side effects of docusate

What to do about:

• feeling sick – try taking docusate with a meal or snack. You could also try mixing your dose with some water or fruit juice.
• diarrhoea – if you’re using docusate for mild constipation and get diarrhoea, stop taking docusate. Your bowels will usually return to normal in a few days. Drink plenty of water or other fluids to prevent dehydration and stop the constipation returning. If your doctor has prescribed docusate for severe or long-term constipation and you get diarrhoea, ask them for advice about what to do. Do not take any other medicines to treat diarrhoea without speaking to a pharmacist or doctor.
• stomach cramps – if you get stomach cramps, reduce your dose of docusate until this goes away.

7. Pregnancy and breastfeeding

If you’re pregnant or breastfeeding, you can try to treat constipation without taking a medicine. This involves eating more fibre and drinking plenty of fluids. It may also help to do gentle exercise.

If diet and lifestyle changes do not work, your doctor or midwife may recommend a laxative, such as lactulose or Fybogel. These laxatives are quite often used during pregnancy and while breastfeeding.

Docusate in pregnancy

Docusate is occasionally used in pregnancy and there is no evidence to suggest it will harm your baby. However, other types of laxative are usually tried first, because there is more information to say that they are safe.

Docusate and breastfeeding

If your doctor or midwife recommends docusate, instead of lactulose or Fybogel, it’s usually ok to use this medicine while breastfeeding. The amounts of docusate found in breast milk are probably very small and are unlikely to affect your baby.

If you notice that your baby is not feeding as well as usual, or if you have any other concerns about your baby, talk to your health visitor, midwife or doctor as soon as possible.

Non-urgent advice: Tell your doctor if you’re:

• trying to get pregnant
• pregnant
• breastfeeding

For more information about how laxatives can affect you and your baby, read this leaflet about treating constipation on the Best Use of Medicines in Pregnancy (BUMPs) website.

8. Cautions with other medicines

Do not take docusate with a mineral oil laxative such as liquid paraffin.

Mixing docusate with herbal remedies and supplements

There’s very little information about taking herbal remedies and supplements with docusate.

Important:
Medicine safety

Tell your doctor or pharmacist if you’re taking any other medicines, including herbal medicines, vitamins or supplements.

9. Common questions about docusate

How does docusate work?

Docusate helps to soften your poo by increasing the amount of water in it. This makes it easier for you to go to the toilet.

Docusate also stimulates the muscles that line your gut, helping poo to move poo along your bowel to your anus.

When will I feel better?

Docusate capsules and liquid normally take 1 or 2 days to work. The enema usually works after 5 to 20 minutes, so it’s best to stay close to a toilet.

Talk to your doctor or pharmacist if you are still constipated after a week.

How long willI take docusate for?

Take docusate for up to 1 week. If you take docusate for longer, your bowel can start to rely on it, rather than working on its own.

If you are still constipated after taking docusate for a week, talk to your doctor.

If your constipation is caused by an illness or a medicine you’re taking, your doctor will advise you about when it’s best to stop taking docusate.

Is it safe to take docusate for a long time?

It’s best to use docusate occasionally and for a few days at a time.

Using laxatives like docusate for longer can lead to long term diarrhoea.

They can also cause an electrolyte imbalance. This means that levels of salts and minerals like sodium, potassium and magnesium in your body get too high or too low. A severe electrolyte imbalance can cause serious health problems such as muscle spasm and twitching, and even fits or seizures.

Using docusate for many weeks, even months, could also stop your bowel working properly on its own.

Can I take different laxatives together?

For most people, 1 laxative will be enough to relieve constipation.

Occasionally, you may need to take 2 different types of laxatives at the same time to get your bowels moving again.

Only take 2 laxatives together on the advice of your doctor or pharmacist as there is an increased risk of side effects.

Are there other laxatives I can try?

There are other types of laxative. They work in a different way to docusate but are equally good at treating constipation.

Bulk-forming laxatives, for example Fybogel. These increase the bulk or weight of poo which in turn stimulates bowel movement. They take 2 or 3 days to work.

Osmotic laxatives, for example lactulose. These draw water from the rest of the body into your bowel to soften your poo and make it easier to go to the toilet. They take at least 2 days to work.

Stimulant laxatives, for example senna and bisacodyl. These stimulate the muscles that line your gut, helping them to move poo along your gut. Senna takes about 8 hours to work.

Is there any food or drink I need to avoid?

You can eat and drink normally while taking docusate.

It might be a good idea to stop eating pastries, puddings, sweets, cheese and cake for a while as these foods can make constipation worse.

Can I drink alcohol with it?

Yes, you can drink alcohol with docusate.

Can I use docusate after surgery?

It’s quite common to have constipation after surgery. Using a laxative may help relieve the discomfort.

If you have constipation after an operation, it’s better to use lactulose because it is gentler than docusate. You can get lactulose from pharmacies.

Can lifestyle changes help constipation?

It’s often possible to improve constipation without having to use laxatives. Before trying docusate – or to stop constipation coming back – it may help to:

• eat more fibre – aim for about 30g of fibre a day. High-fibre foods include fruit, vegetables and cereals. If you’re not used to a high-fibre diet, increase the amount of fibre you eat gradually.
• add bulking agents, such as wheat bran, to your diet. These will help make your poo softer and easier to pass (although bran and fibre can sometimes make bloating worse).
• drink plenty of water – to keep poo soft
• exercise regularly – keeping your body active will help to keep your gut moving

Don’t bomb the bowel with laxatives

Occasional irregularity is a fact of life, but you can minimize it with some basic steps. You should be sure you are eating a fiber-rich diet, drinking adequate fluids, and staying physically active.

But when you have constipation, the best laxative is the gentlest and safest option, like a bulk-forming laxative. If laxatives don’t work, ask for help. You should see your doctor and discuss it if you are constantly needing to take laxatives.

How do stool softeners work?

Stool softeners work by softening stools to make them easier to pass. They can be in capsule, tablet, liquid, and syrup form and are usually taken at bedtime. Be sure to take stool softeners exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

First choice: bulk-forming laxatives

Bulk-forming laxatives draw water into stool, making it softer and easier to pass. But don’t expect instant gratification: these can take a half-day to several days to provide relief. They are safe to use daily. They contain various ingredients, and you may have to try more than one to find the product that helps you with minimal side effects, such as flatulence and bloating. They may be marketed as laxatives or as fiber supplements.

For stuck stools…

Stool softeners add moisture to stools to make them softer and easier to pass. Mineral oil, a lubricant, helps stools “slide on by” if the stools feel stuck low in your bowels, if you have an internal tear or “fissure,” or if you have pain from hemorrhoids during bowel movements.

Don’t take mineral oil at the same time as stool softeners. Take 1 tablespoon at breakfast or lunch. But don’t use it for more than a few days, because mineral oil interferes with absorption of some vitamins and if inhaled it can cause pneumonia. Consider wearing a protective pad in your undergarments to absorb any leakage.

Other laxative options

If stool softeners aren’t providing enough help, the osmotic laxative polyethylene glycol (MiraLAX or a generic version) is good next step. These products hold water in stool to soften it and increase bowel movements. Common side effects are gas, bloating, and nausea.

Another option that works for some people is diet candies containing the sweetener sorbitol. These essentially trigger a mild case of the runs. You may experience bloating and gas along with the laxative effect, however.

Another option would be a magnesium-based laxative, such as milk of magnesia or magnesium citrate. These are members of a larger class of laxatives called saline osmotics, which draw water into the bowels and trigger bowel movements. The active ingredients include magnesium, sulfate, citrate, and phosphate.

But don’t take more than the recommended amounts of these laxatives, or use them long-term, because they can throw off your chemistry. Combined with an underperforming kidney or heart failure, saline osmotic laxatives can be dangerous.

Stimulant laxatives

Stimulant laxatives such as senna and bisacodyl trigger contractions in the bowels that push the stool along. But if you take stimulant laxatives too often, you could become dependent on them to have a bowel movement at all — possibly because the bowel has stopped functioning normally.

When to talk to a doctor

If you find yourself trying one laxative after another, see your doctor for an evaluation. Additional testing can lead to better therapy and rule out any possible serious malfunctions. And if it is just constipation, your doctor can offer other medications to you that may be more helpful than over-the-counter laxatives.

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How many days can constipation last and what to do

How many days of stool retention in adults can be considered constipation?

How many days of stool retention in adults can be considered constipation?

Constipation is a violation of the function of bowel movement, in which the intervals between acts of defecation increase to 3 days or more, and there is also significant physical discomfort in the process of bowel movement ^{1, 3} .

There is no unambiguous answer to the question of how many days of stool retention in an adult can be considered constipation, and cannot be. The normal rhythm of bowel movements for a person can be determined by the nature of nutrition and other individual characteristics. The use of a large amount of food containing coarse vegetable fiber, while limiting protein products, may be accompanied by two to three bowel movements per day ⁵ .

On a mixed diet, daily stools in the morning are normal. In those whose diet is dominated by refined foods, the frequency of bowel movements (up to 3 per week) and the volume of feces are simultaneously reduced. Stool frequency is not a cause for concern as long as bowel movements are not accompanied by discomfort ⁵ .

On a mixed diet, daily stools in the morning are normal. In those whose diet is dominated by refined foods, the frequency of bowel movements (up to 3 per week) and the volume of feces are simultaneously reduced. Stool frequency is not a cause for concern as long as bowel movements are not accompanied by discomfort ⁵ .

Main causes and symptoms
Main causes and symptoms

In healthy adults, ^{1, 5} can provoke stool retention:

psychogenic
causes – anxiety and depression

medication

physical inactivity

9000 6

reduction in the proportion of products containing coarse vegetable fiber in the diet

The main symptom of constipation is the absence of voluntary defecation
for several days. Also, constipation is considered to be the need to push with the urge to defecate with soft feces, the appearance of hard fragmented stools, a significant increase in the diameter and density of the fecal cylinder, which, when separated, injures the mucous membrane of the rectum and anus, a feeling of incomplete emptying of the intestine ⁵ . It is not uncommon for a person to have to help himself manually by pressing his hand
on the area of ​​the pelvic floor, removing the stool with his finger ⁴ .

No matter how long constipation lasts in an adult, the absence of stool and discomfort during bowel movements may not be considered by the patient as a sufficient reason to visit a doctor
, although in fact this is not the case ^{1, 3} . It is often not customary to talk about the problem of constipation in general, and it happens that the Internet becomes the only “consultant” for the patient.

No matter how long constipation lasts in an adult, the absence of stool and discomfort during bowel movements may not be considered by the patient as a sufficient reason to visit a doctor
, although in fact this is not the case ^{1, 3} . It is often not customary to talk about the problem of constipation in general, and it happens that the Internet becomes the only “consultant” for the patient.

What to do with stool retention?
What to do with stool retention?

Consider the algorithm of actions in cases where constipation lasts for several days in a healthy adult.

The first and most important thing to do is to remember how often a bowel movement is normal and how much your own feelings have changed when trying to go to the toilet. It is worth talking about constipation
in cases where the deviation from the individual norm is
48 hours or more, and there are also characteristic symptoms (hard stools, pain during bowel movements, the need to push, etc.) ^{1, 4, 5} .

If problems with a chair have arisen for the first time, it is necessary, if possible, to determine the cause of the delay in the chair. If there have already been difficulties with defecation, it is better to contact a specialized gastroenterologist and undergo the necessary examination. Treatment of constipation should be comprehensive. In addition to taking laxatives, it includes recommendations for lifestyle and dietary changes ^{1, 3-5} .

Danger of stool retention
Danger of stool retention

Stretching of the smooth muscle fibers of the intestinal wall by accumulating fecal masses, including suppression of the urge to defecate, may contribute to constipation ⁸ .

Constipation is not just stool retention
Constipation is not just stool retention

Constipation has a significant negative impact on the patient’s quality of life ^{1, 3} .

Constipation leads to unpleasant symptoms that are not directly related to the act of defecation, such as lethargy, feeling of heaviness and fullness in the abdomen, decreased mood ⁶ .

Constipation fixes patients’ attention on bowel function: they begin to pay too much attention to the quantity and quality of stools ⁶ .

Long term constipation management

Recurring bowel problems are cause for concern and action. To do this, first of all, you need to contact a doctor who will determine the cause of constipation and give the necessary recommendations, including on lifestyle modification and nutrition correction ^{1, 4, 5} :

In addition to lifestyle recommendations, your doctor may also prescribe laxatives ^{1, 4, 5} .

increase the amount of foods containing coarse vegetable fiber in the diet: vegetables, fruits, bran;

drink at least 2 liters of fluid per day;

increase physical activity.

One of the laxatives is Guttalax®

⁹ .

Its active ingredient, sodium picosulfate, has a dual mechanism of action: it not only promotes colon peristalsis, but also helps soften stools ⁹ . In addition, Guttalax® is available in drops, which allows you to individually select the appropriate dose of laxative ⁹ . It is also worth noting that Guttalax® is not only not addictive when taken in recommended doses, but also does not require a course of administration – it can be used once as needed, exactly when there is such a need ⁹ . With prolonged constipation, it is imperative to consult a doctor who will determine the cause of constipation and give recommendations, and not resort to self-medication.

More about the drug

Comparative studies show that the effectiveness of colon cleansing when using a low-volume regimen did not suffer, and overall tolerability improved ⁹ .

Bisacodyl is a local laxative that acts specifically in the large intestine ¹⁰ . Bisacodyl enhances peristalsis and promotes the accumulation of water and electrolytes in the lumen of the colon. This leads to stimulation of defecation, reduction of evacuation time and softening of the stool. Bisacodyl is the active ingredient in Guttalax® Express ¹⁰ .

CONTRAINDICATIONS. IT IS NECESSARY TO CONSULT WITH A SPECIALIST.

Bisacodyl instructions for use, price: Overdose, side effects

THERE ARE CONTRAINDICATIONS. POSSIBLE SIDE EFFECTS. A SPECIALIST’S CONSULTATION IS NECESSARY. Constipation

The author of the article

Pogorelova Evgenia Sergeevna,

Candidate of Pharmaceutical Sciences, pharmacist

All authors

Content of the article

• Bisacodyl: what helps
• Bisacodyl: after how long it works
• Bisacodyl does not work: what to do
• How to speed up the action of Bisacodyl
• Bisacodyl side effects
• Bisacodyl: Overdose
• Summary
• Ask an expert on the subject of the article

Regular stool is a stable work of the gastrointestinal tract and a guarantee of good health. According to statistics, constipation occurs in 12-19% of the adult population, and in people over 60 in 36% of cases. To prevent problems with bowel movements, it is recommended to follow a diet, drink enough water and lead an active lifestyle. If constipation still appears, then along with the main treatment, the doctor will prescribe a laxative.

Pharmacist Evgenia Pogorelova will talk about the laxative drug Bisacodyl, how long it takes to start working, what side effects it has, and what happens in case of an overdose.

All products Bisacodyl

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Bisacodyl: what helps

Bisacodyl is a laxative based on the active ingredient of the same name. Available in the form of 5 mg tablets and 10 mg rectal suppositories in Russia, Latvia, Serbia and Germany. The drug causes irritation of receptors in the intestinal mucosa, which increases its mobility and increases the production of mucus. This promotes the movement of undigested food debris.

Bisacodyl indications:

• constipation caused by poor intestinal motility in old age or after surgery
• stool normalization for hemorrhoids, proctitis and anal fissures
• preparation for operations or instrumental examinations: X-ray, endoscopy, colonoscopy and others

Bisacodyl: how long does it take to work

A common question: “How quickly does Bisacodyl work?”. The time of occurrence of the effect depends on the dosage form of the drug. Bisacodyl tablets begin to act 6 hours after ingestion, but when taken at bedtime, the time increases to 8-12 hours. With rectal administration, a laxative effect occurs within 10-30 minutes, depending on the individual characteristics of the organism.

Bisacodyl does not work: what to do

It is important to remember that Bisacodyl tablets do not start to show their effect immediately. If within 12 hours the laxative effect of the drug is not manifested, you can repeat the intake at a minimum dose of 5 mg. The maximum daily dosage is 15 mg.

Re-use of suppositories can be done only after a day. If in this case there is no result from the medicine, it is necessary to consult a doctor about replacing the drug.

How to speed up the action of Bisacodyl

Bisacodyl is a powerful laxative and there is no need to speed up its action. The only thing that can be done is to correctly follow the rules for taking the medicine. Bisacodyl is taken orally at bedtime or 30 minutes before breakfast. Tablets should be swallowed without chewing and with a small amount of water. In case of urgent need for a laxative effect, apply suppositories.

Bisacodyl: side effects

Long-term use of Bisacodyl in high doses will lead to excessive loss of water and electrolytes, which is dangerous for the body. As a result, muscle weakness, heart failure, seizures and an excessive decrease in blood pressure may occur.

Common side effects include:

• nausea
• abdominal pain and heaviness
• flatulence
• allergic reactions

Bisacodyl: overdose

When using Bisacodyl, it is important to follow your doctor’s instructions and instructions and not to take the drug without indications. Otherwise, there is a risk of overdose, the consequences of which can be serious. These include:

• Chronic diarrhea
• Dehydration
• Abdominal cramps and pain
• An excessive decrease in the level of potassium in the blood, which causes psycho-emotional instability, muscle weakness and rapid physical fatigue, as well as increased urination, shortness of breath and abnormal heart rhythm
• Development of urolithiasis
• Damage to the kidneys and renal tubules

There is no specific treatment for laxative overdose. Therapy is aimed at eliminating the consequences of drug abuse: replenishment of fluid and electrolytes, as well as antispasmodics for pain.

Summary

• Regular stools are essential for a stable gastrointestinal tract and a guarantee of well-being
• Bisacodyl is a laxative based on the active ingredient of the same name
• Bisacodyl tablets begin to act 6 hours after ingestion, when administered rectally, the effect begins within 30 minutes.
• It is important to remember that Bisacodyl tablets do not start to take effect immediately.
• Bisacodyl is a strong laxative and there is no need to accelerate the action
• Long-term use of Bisacodyl in high doses will lead to excessive loss of water and electrolytes, which is dangerous for the body
• It is important to follow the Bisacodyl regimen, otherwise there is a risk of causing an overdose, the consequences of which can be serious

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