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Cover of Dioctyl Sulfosuccinate or Docusate (Calcium or Sodium) for the Prevention or Management of Constipation: A Review of the Clinical Effectiveness

Dioctyl Sulfosuccinate or Docusate (Calcium or Sodium) for the Prevention or Management of Constipation: A Review of the Clinical Effectiveness

Rapid Response Report: Summary with Critical Appraisal

Constipation has many definitions and is often described differently depending on the population queried. Many physicians define constipation as a reduction in the frequency of bowel movements to fewer than three times per week while patients identify more with the symptoms associated with constipation such as difficulty passing stool, hard stool consistency, feelings of abdominal cramping, and feelings of incomplete stool passage. Causes of constipation may be primary (idiopathic) or secondary to other factors such as diet, medication, or medical conditions. Constipation can affect anyone as a minor annoyance but up to a quarter of the population experiences it chronically or severely. It can substantially affect quality of life and be debilitating. It is estimated that between 2% to 27% of the population are affected depending upon the definition of constipation used.

Chronic constipation is a significant problem in the elderly,, in patients with chronic conditions,– and in patients receiving opioids as part of a treatment regimen.– Up to 20% suffer from chronic constipation in the community-dwelling elderly population while this number increases to approximately 50% to 75% in institutionalized elderly patients. Approximately 90% of patients treated with opioids for non-cancer pain suffer from constipation with this number rising to 95% in patients treated for cancer pain. Chronic constipation can be defined using any one of three options: the Rome III criteria for functional constipation, the American College of Gastroenterology definition, or the American Gastroenterological Association definition.

Current treatment options include dietary or bulking agents (i.e. psyllium seed husk), osmotic laxatives (i.e. lactulose, sorbitol, polyethylene glycol [PEG]), stimulant laxatives (i.e. sennosides, bisacodyl, sodium picosulfate), and stool softeners (i.e. docusate sodium or calcium)., In North America, docusate and a stimulant laxative such as sennosides are commonly used in bowel treatment protocols associated with institutionalized elderly and oncology treatments. A paucity of evidence is available to support the use of the stool softener docusate yet it continues to be prescribed in everyday clinical practice for the aforementioned populations.– While the actual cost of docusate is low, additional costs associated with its administration (i.e. nursing time) and its widespread use can be significant. Therefore, this review was undertaken to determine the clinical effectiveness of docusate for the prevention or management of constipation.

Disclaimer: The Rapid Response Service is an information service for those involved in planning and providing health care in Canada. Rapid responses are based on a limited literature search and are not comprehensive, systematic reviews. The intent is to provide a list of sources of the best evidence on the topic that CADTH could identify using all reasonable efforts within the time allowed. Rapid responses should be considered along with other types of information and health care considerations. The information included in this response is not intended to replace professional medical advice, nor should it be construed as a recommendation for or against the use of a particular health technology. Readers are also cautioned that a lack of good quality evidence does not necessarily mean a lack of effectiveness particularly in the case of new and emerging health technologies, for which little information can be found, but which may in future prove to be effective. While CADTH has taken care in the preparation of the report to ensure that its contents are accurate, complete and up to date, CADTH does not make any guarantee to that effect. CADTH is not liable for any loss or damages resulting from use of the information in the report.

Copyright © 2014 Canadian Agency for Drugs and Technologies in Health.

Copyright: This report contains CADTH copyright material and may contain material in which a third party owns copyright. This report may be used for the purposes of research or private study only. It may not be copied, posted on a web site, redistributed by email or stored on an electronic system without the prior written permission of CADTH or applicable copyright owner.

Links: This report may contain links to other information available on the websites of third parties on the Internet. CADTH does not have control over the content of such sites. Use of third party sites is governed by the owners’ own terms and conditions.

Except where otherwise noted, this work is distributed under the terms of a Creative Commons Attribution-NonCommercial- NoDerivatives 4.0 International licence (CC BY-NC-ND), a copy of which is available at

Bookshelf ID: NBK259243PMID: 25520993


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