Your Good Health: Stool softeners are safe to use and do not cause habituation

dr_keith_roach_with_bkg.jpgDear Dr. Roach: I’m an 84-year-old man who has recently found relief from lifelong strain in bowel movements by using stool softeners. I would like to know if they’re habit-forming if taken once a day. I’ve tried Metamucil but the results were not as good. Please comment on both. Thank you.

B.C.

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Straining for a bowel movement is unhealthy to the bowel and puts increased stress on many structures, leaving a person at higher risk for developing diverticula of the colon and symptomatic hemorrhoids. Diverticula are small pouches in the colon wall, which can bleed or become inflamed. First-line treatment for hard bowel movements includes regular exercise and dietary changes, especially increasing fresh fruit and other foods containing fibre. One food that is especially helpful, proven by generations of use as well as clinical studies, is prunes, which contain several substances in addition to fibre that help prevent hard bowel movements.

When diet changes alone are inadequate, then medical treatment is appropriate. Psyllium husk, such as in Metamucil, is another time-tested treatment that is effective. Stool softeners, such as sodium docusate (Colace and others), are another option. Most people find psyllium is superior, but if the stool softeners are working well for you, there is no need to stop them. They are safe and do not cause any kind of habituation nor long-term effects on the colon. As I first noted, straining is harmful, so treatment can prevent problems.

Many people with constipation force themselves to drink a great amount of water. While it is certainly true that not drinking enough water can cause some constipation, this isn’t common. Most people do not benefit by going from normal water consumption to very high levels, and excess water drinking can have problems of its own, especially in people on diuretics, such as hydrochlorothiazide or furosemide (Lasix).

Dear Dr. Roach: Can a skin test show if a person will react poorly to a COVID-19 vaccine? I’ve had serious allergic reactions to many drugs. I’m too afraid to risk getting the shot. Can it be given in half doses to lessen potential adverse effects? I won’t get the shot without some assurance.

M.L.

The risk of a serious allergic response to a COVID-19 vaccine is small, approximately five people per million. The vast majority of these occurred in people with previous serious allergic reactions and occurred within 30 minutes of the vaccine.

People with a history of severe allergic reaction, such as anaphylaxis, to any vaccine should be referred to an allergist for evaluation prior to vaccination. The allergist may do testing, such as skin testing, prior to giving the vaccine. The vaccine should be given where trained experts and appropriate equipment is immediately available in the unlikely case of a severe reaction.

People with other kinds of allergic responses to foods or medicines, such as a rash to penicillin, are probably at no higher risk than the general population to get a severe reaction to the COVID-19 vaccine. You should definitely speak with your physician about your personal risk. Most people will be able to get the vaccine with no trouble.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu

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