When to Use Stool Softeners vs. Laxatives, According to Gastroenterologists
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Fact checked by Nick Blackmer
Key Takeaways
Constipation can often be treated with over-the-counter (OTC) products like stool softeners and laxatives.
Stool softeners make it easier for stools to pass when you have a bowel movement. Laxatives stimulate the gut to increase bowel movements.
Experts say whether you should use laxatives or stool softeners depends on your specific situation and needs. You should always talk to your healthcare provider before you start using laxatives.
Constipation is a common problem and chances are you’ve experienced it before. Being constipated can mean not having bowel movements often or having bowel movements that are hard to pass. It can cause symptoms like abdominal pain and bloating.
For most people, occasional constipation can be treated and managed with a combination of lifestyle changes and over-the-counter (OTC) products like stool softeners and laxatives.
If you’ve ever taken a stroll down the GI health aisle at your local pharmacy looking for relief, you know there are so many types of OTC laxatives and stool softeners to choose from. How do you know which one you need?
Here’s what experts say about the differences between stool softeners and laxatives, and how to know which to pick when you’re constipated.
Related: Am I Constipated?
How Laxatives Work
Brooks Cash, MD, a gastroenterologist with UTHealth Houston, told Verywell that laxatives are medications that make bowel movements easier to have and more frequent. Cash said there are many types of laxatives that you can buy OTC at the pharmacy or grocery store. They come in different forms, like oral capsules, tablets, gummies, and liquids.
According to Ashkan Farhadi, MD, a gastroenterologist at MemorialCare Orange Coast Medical Center in Fountain Valley, CA, some of the main types of laxatives are:
Bulk-Forming Laxatives: These work by adding moisture and weight to the stool, which makes it softer and easier to pass. Psyllium husk and methylcellulose are found in common OTC brands of bulk-forming laxatives like Citrucel (methylcellulose), Metamucil (psyllium), FiberCon (polycarbophil), Konsyl (psyllium), and Benefiber (wheat dextrin).
Osmotic Laxatives: These work by drawing water into the intestines from the rest of the body, which softens stool and increases bowel movements. Common OTC products are Milk of Magnesia (magnesium hydroxide) and Miralax (polyethylene glycol), as well as lactulose.
Stimulant Laxatives: These work by irritating the intestines, which increases contractions in the colon to force stool to move along. Common OTC brands are Senokot (senna), Fleet (bisacodyl), and Dulcolax (bisacodyl).
Most people can safely take laxatives if needed, but Cash said that people with chronic medical conditions (especially a history of bowel obstructions), chronic kidney disease, electrolyte abnormalities, as well as pregnant people should always ask their provider before taking a laxative. Caregivers should also talk to their child’s provider before giving them a laxative.
What Are the Risks?
OTC laxatives and stool softeners are safe for most people as long as they’re used according to the instructions. That means not taking a higher dose or using them for longer than directed (unless your provider tells you to). There are some risks that come with using OTC laxatives, including:
Dehydration and electrolyte imbalances: You can get dehydrated if you’re not drinking enough water when you’re using a laxative, which can throw off your electrolytes and cause serious symptoms. Osmotic and bulk-forming laxatives also may not work as well if you’re not hydrated. If you’re using a magnesium-based laxative and too much magnesium builds up in your system, it can be hard on your kidneys. The same can be true for laxatives (like saline enemas) that have sodium phosphate in them.
Bowel blockage: Drinking enough water is also really important if you’re taking a bulk-forming laxative. Staying hydrated will help keep the substances from possibly causing a blockage in your intestines (bowel obstruction).
Dependence: Stimulant laxatives like bisacodyl and senna can lead to dependence if you take too many or use them for a long time. People who misuse stimulant laxatives may get to the point where they cannot have regular bowel movements without them, and the colon can even become damaged.
Related: OTC Laxatives 101
Sheila Rustgi, MD, a gastroenterologist at Columbia University Irving Medical Center, told Verywell that common side effects of laxatives include diarrhea, abdominal pain, gas, cramping, nausea, and bloating.
While you’d expect that laxatives would make you go more, if you develop watery stools, Rustgi said that’s a sign you’re taking more than you need and should reduce the dose and/or take them less often.
People who have severe, chronic constipation may not be helped by OTC laxatives and might need prescription medications. Some people need to take OTC or prescription laxatives daily, while others just need them once in a while.
In general, Cash said people should “follow the instructions provided for any laxative they buy or are prescribed.”
Learn More: The Different Kinds of Laxatives
How Stool Softeners Work
Farhadi said that stool softeners (also known as emollient laxatives) are substances that can be very helpful if your stool is dry and hard.
According to Rustgi, stool softeners work by increasing the water content in the stool so it can absorb more water and fat, making it softer and easier to pass when you have a bowel movement.
Rustgi said stool softeners “are especially good for short-term use, like after a surgery when you are less mobile and may be taking prescription painkillers to prevent constipation.”
Most people can take stool softeners safely. They’re OTC and come in different forms including oral soft gels, capsules, tablets, and oral liquid forms. Colace, Correctol, DulcoEase, Phillips’ Stool Softener, and Modane Soft are common OTC stool softener brands.
The potential side effects of stool softeners are stomach cramps, stomach pain, diarrhea, weakness, hives, or vomiting. While stool softeners are generally safe, Cash said that people should still talk to their providers before taking them—especially if they have any underlying medical conditions.
Learn More: What Are Stool Softeners?
Stool Softeners vs. Laxatives: How to Choose
How do you know if you need a stool softener or a laxative? Experts say that you should go by how severe your symptoms are and how long you’ve been having symptoms. You also need to consider your specific situation and needs.
Cash said that generally, “laxatives have more evidence to support their efficacy in patients with chronic constipation and stool softeners are more appropriate for patients with occasional constipation.”
Here are a few examples of when to choose a laxative vs. a stool softener:
Laxatives are generally better if:
You have symptoms of constipation (including having fewer than 3 bowel movements per week or having not had a bowel movement for several days)
You are looking for faster or immediate relief
Stool softeners on their own have not helped
You have severe or chronic constipation (e.g., more than 12 weeks of symptoms, such as hard stools and/or straining in at least 25% of bowel movements)
Your healthcare provider recommends a specific type of laxative to help you manage your condition
Stool softeners are generally better if:
You want to prevent constipation (especially if you’re at risk because you have certain medical conditions or take certain medications)
You have hard, dry stools that are difficult to pass comfortably
You have temporary or mild constipation (for example, you only get “backed up” when you travel)
Your healthcare provider has recommended that you take stool softeners
“If someone doesn’t feel well from constipation, with bloating and heaviness and maybe even pain, I would recommend a laxative for quicker relief,” said Rustgi. “Sometimes a rectal glycerin suppository can help to soften stool near the rectum and make it pass if it’s really hard. In this situation, softeners are likely too gentle.”
Cash said that again, you should always talk to your healthcare provider before starting an OTC medication—especially if you’re not sure which one to choose.
Related: How to Get Relief If You're Constipated
Other Constipation Treatments
Aside from OTC medications, there are also other strategies that can help you manage constipation and even prevent it.
Dietary changes: Adding more fiber-rich foods to your diet, such as whole grains, apples, and dried fruits like prunes, and flax seeds, can help ease and prevent constipation. Try to get at least 25 grams of fiber daily. Make sure you’re drinking enough fluids daily, including water and fruit juices, to prevent constipation. “Adequate fiber and water in the diet can help stool pass through the intestines more easily,” said Rustgi.
Exercise: Getting regular physical activity can help stimulate the digestive system and keep your bowels regular. When you exercise, blood flow increases throughout your GI tract. This helps create stronger intestinal contractions and decreases how long it takes stool to move through the digestive system. “Increasing dietary fiber and exercise are the most effective lifestyle modifications to treat constipation,” Cash said.
Bowel training: Farhadi recommends training yourself to use the bathroom at the same time every day. Bowel retraining, as it’s called, can promote more regular bowel movements. Try to make it a habit to use the bathroom right after breakfast or lunch, since eating encourages your colon to get things moving. Remember to relax and avoid straining or rushing when you’re in the bathroom. “Set a time that works for you every single day. When you repeat that every single day, you’ll see that your body gets the message and the body will deliver,” said Farhadi.
And if you feel like you’ve tried everything and you’re still not getting relief, talk to your provider. They can figure out what’s causing your constipation and figure out what treatment—or combination of treatments—will be the best way to help manage your symptoms.
What This Means For You
Stool softeners and laxatives can both ease constipation but have different uses. Stool softeners can be used if you have temporary or mild constipation. Laxatives are generally recommended if your constipation is severe and you need faster relief. If you are unsure which one to take, ask your healthcare provider.
Read Next: What Causes Chronic Constipation?
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