Stool softeners: uses, side effects, and contraindications:

What are stool softeners?

Stool softeners are medications that are used to loosen hard stools or prevent hard stools.

When to use stool softeners?

Stool softeners are used for the following purposes:

Clean the colon before any procedure that needs general anesthesia; this is called colon prep. It is necessary because, during anesthesia, the rectal muscles become relaxed and lose muscle tone, which can cause the patient to defecate during the surgery.

Cleaning of the colon before any surgery or procedure:

 If you are advised to undergo some procedures, such as a colonoscopy, in which the doctor has to see the internal parts of the colon, it is necessary to clean the colon with a strong laxative for better results. Per rectal enemas are usually used for the cleaning of the colon.

To lower potassium levels:

Some enemas, known as kayexalate enemas, are used to lower some electrolytes, such as potassium levels in the blood. When enemas are given into the colon, they bind to the potassium and remove it in the stool.

To reduce swelling related to disease inside the colon:

Some steroid enemas are used to reduce inflammation inside the colon. These enemas are called steroid enemas.

Prevent constipation or hard stools:

Loosen hard stools, especially in babies and the elderly population

Prevent constipation in some cases, such as anal fissure or fistula, to prevent the risk of bleeding.

Prevent strain on the wound:

Patients after surgery, such as after childbirth, abdominal surgeries, chest surgeries, and spinal surgeries, who do not have to strain, need stool softeners to avoid pressure on surgical stitches or wounds.

• Laxatives are used in babies with some colon defects:

Babies born with some diseases, such as Hirshsprung’s disease, are unable to defecate by themselves. In such babies, some cells called nerve cells (the ganglion cells) help the movement of colon muscles, which leads to the accumulation of stool in the colon, leading to hard stools. These hard stools are difficult to pass. Using laxatives in such babies helps the stool to pass easily.

• Babies on formula milk:

Babies on formula milk usually suffer from severe constipation, especially when the dry milk powder formula and water quantity are not equal. It is recommended that the water used for the dilution should be a little greater than the powder. Secondly, do not use cold water; always use lukewarm water when making the bottle feed.

How do stool softeners work?

Stool softeners work by pulling water and fats into the large intestines to make the stool soft and looser. This makes stools softer and helps them pass more easily.

What are the different types of stool softeners?

Stool softeners come in different forms, such as

• Pills: if your healthcare provider has advised stool softeners or laxatives in pill /tablet form, you must take the tablet /pill as a whole; do not chew or crush it. Drink the whole tablet with a full glass of water.

Secondly, follow the instructions of your healthcare provider or follow the leaflet inside the packaging.

Do not exceed the recommended dose, which could cause serious complications such as excessive diarrhea.

• Syrups:

If the laxatives are advised in syrup form, they must be taken with water to change the sweet and bitter taste.

• Per rectal enemas:

 If your healthcare provider has advised you to use rectal enemas, always seek expert help for the administration to prevent complications such as a tear to the anal area.

Are there any side effects of stool softeners?

Yes, stool softeners have side effects as well. Besides promoting loose stools, stool softeners have the following side effects.

• Could cause more than required loose stools, e.g., diarrhea
• Increased bowel movement can lead to abdominal cramps
• Causes electrolyte imbalance and dehydration due to frequent loose stools
• Causes headaches

What happens if stool softeners are used frequently?

Stool softeners should not be used regularly. It makes the gut habitual and addicted to stool softness. It is a normal phenomenon of the gut that it moves, called peristaltic movement, but when a stool softener or laxative is used regularly, the gut stops its movement, and this decrease in movement causes the stool to slow down and causes constipation.

Are there any contraindications for stool softeners?

What will happen if stool softeners are used frequently?

If stool softeners are used constantly, it will worsen the condition by making the gut habituated to laxatives. Furthermore, the person will not be able to pass stool by himself.

Which medications are not suitable with stool softeners?

Try not to take other medications with stool softeners, as the stool softeners increase gut motility, which could interfere with drug absorption.

Which medical terms and medicines cause constipation?

Constipation is a condition that everyone can suffer from. Whether it’s a child, a young person, or an elderly person. However, some risk factors lead to constipation. The risk factors are as follows:

• Lower fluid intake
• A diet low in fiber
• Heavy intake of caffeine or caffeinated drinks
• Patient on long-term painkillers such as opioids
• Lack of physical activity
• Patients on drugs such as antiepileptics or antidepressants
• People living in cold climates( lower fluid intake)
• People who are habituated to taking laxatives are more prone to constipation.
• Patients on chemotherapy
• Patients with abdominal surgeries
• Patients with hemorrhoids or anal fistulas
• During pregnancy, especially in the second and 3rd trimester, due to the uterine pressure on the large intestine, women suffer from severe constipation.
• Patients with long-term disabilities are at a higher risk of developing constipation.

What are the natural ways to treat constipation?

Besides medical ingredients used to relieve or prevent constipation, there are some natural home remedies to prevent and treat constipation. These remedies are as follows:

• Make a routine for the toilet: try to train your bowel at the same time every day; this will train the mind as well as the gut. Moreover, it’s a natural phenomenon that after breakfast, at around 30 minutes, every person feels the urge to defecate. Going to the toilet at the same time will make the bowel habitual and trained.
• Keep yourself hydrated all the time by keeping a water bottle with you.
• Add green vegetables and salad to your diet.
• Take a ½ glass of lukewarm water at bedtime.
• Do abdominal massage in a circular motion, starting from the lower part of the belly to the upper side up to the ribs, then move to the left side, and then down the left side. This massage will improve bowel movement and relieve constipation.
• Add some organic oils to your diet or take a spoonful of pure oil. These organic oils are almond, walnut, apricot oil, etc.
• Use cumin seed ( jeera in Hindi) with milk. It has many other health benefits, including being the best remedy for constipation.
• Do foot reflexology

Hence,, constipation is a major issue atat all ages. Managing it with lifestyle changes and dietary adjustments should be the first step, whereas medical management, such as stool softeners, should be used with caution; always use them under the supervision and advice of a healthcare provider.