The Laxative Aisle: What the 2023 Constipation Guideline Recommends, and Where Stool Softeners Fit
Bloating & DigestionArticleFiber, powders, stimulant tablets, magnesium and stool softeners all promise relief. A 2023 guideline from two major gastroenterology societies rated the evidence for each. Polyethylene glycol got a strong recommendation, and docusate, the classic stool softener, got none because the data were too thin.
In this article
Long-term constipation affects about 8% to 12% of people in the U.S.1 In 2023, the American Gastroenterological Association and the American College of Gastroenterology1 reviewed the evidence for the medicines people use most and made 10 recommendations.1 Here is how the aisle sorts out.
Strong recommendations
- Polyethylene glycol (PEG) powder. It’s strongly recommended, and its benefit held up over 6 months. Side effects include bloating, loose stools, gas and nausea.1 Our comparison of PEG and bisacodyl goes deeper.
- Bisacodyl or sodium picosulfate (stimulant laxatives), for short-term use (daily for 4 weeks or less) or as rescue when you’re stuck.1 Longer use is probably fine, but more data are needed.1
- Several prescription medicines also got strong recommendations.1
Conditional (“suggested”) options
- Fiber supplements. Of the fiber types studied, only psyllium appeared to work. Gas is common.1 See our guide to psyllium before you stir.
- Magnesium oxide. Suggested, but avoid it if you have kidney disease because magnesium can build up.1 Our article on kiwifruit, prunes and magnesium covers food options.
- Senna. Suggested; trial doses were higher than people often take, so the panel suggests starting low.1
- Lactulose, a prescription syrup, for people who don’t do well with store-bought options.1
Where stool softeners land
Docusate, the classic stool softener, was included in the review but got no recommendation. The panel noted a lack of data for some of the most commonly used treatments, docusate among them.1 If a stool softener alone isn’t helping, ask whether a better-studied option makes sense.
Choosing with your clinician
The guideline encourages choosing together based on your preferences, cost and availability.1 Bring a list of everything you’ve tried and for how long.
Questions to ask
- Could a medicine or a health condition be causing my constipation?
- Which option should I try first, and for how long?
- Is magnesium safe for my kidneys?
- When should I come back if it isn’t working?
Try: “I’ve taken a stool softener every day for a year and I’m still straining. Should I switch to something with better evidence?”
Bloated by Dinner includes a Belly Clock log and a Test-It list with a visit script. Use them to record what you take, how often you go and how it feels. See the book.
This article is for general educational purposes only and is not medical advice. It isn't a substitute for diagnosis or treatment from a qualified healthcare professional who knows your health history. Please don't ignore professional advice or delay getting care because of something you read here. New constipation after 50, blood in the stool, black stools, unexplained weight loss, or severe belly pain need prompt medical care. If you think you may be having a medical emergency, call 911 or your local emergency number right away. This article discusses categories of medicines and a clinical guideline. It does not evaluate any particular brand or product. Girl Playbook does not endorse any specific product, test, or provider.
Girl Playbook sells this book. It provides education and worksheets, not individualized medical care.
Sources
The research behind this article, in the order it’s cited. How we source our articles.
- Gastroenterology (full text via PubMed Central), 2023American Gastroenterological Association-American College of Gastroenterology Clinical Practice Guideline: Pharmacological Management of Chronic Idiopathic Constipation (opens in a new tab)abcdefghijklm
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