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

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Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2014 Jun 26.

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

No authors listed.


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.

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