2-31. FECAL SOFTENERS
During prolonged bed rest and dietary change, it may be necessary to prevent
dessication, hardening, or impaction of feces within the colon and facilitate defecation
by maintaining a soft stool. Fecal softeners include agents that mix with the intestinal
contents and others which serve as emulsifying agents.
a. Mineral oil (heavy liquid petrolatum), also known as an emollient cathartic,
softens the fecal material by becoming emulsified with it. It is probably harmless when
taken on an occasional basis. However, if it is taken chronically, it may impair the
appetite and interfere with the absorption of fat-soluble vitamins. The usual dose is 15
b. Dioctyl calcium sulfosuccinate (Surfak) is an emulsifying ("surface-acting" or
"wetting") agent that probably causes the fats and water in the intestine to mix and form
a soft stool. It should not be used with mineral oil since it might facilitate absorption of
mineral oil into the body. It is widely used in persons who should not strain at stool,
such as those with hemorrhoids, and in older persons to avoid constipation. The usual
dose is 240 mg.
c. Dioctyl sodium sulfosuccinate (Colace) lowers surface tension and is thought
to soften the contents of the intestines by causing the contents to absorb water. It
should not be used with mineral oil since it might facilitate absorption of mineral oil into
d. Psyllium dycrophilic mucilloid (Metamucil) is a light-colored, slightly granular
powder with only a slight acid taste. It consists of the mucilaginous portion of blond
psyllium seeds. It acts as a fecal softener, is demulcent, nonirritating, and may be used
over long periods. Not only does it increase intestinal activity, but it has psychological
value for some clients in that it increases the bulk of the stool. The usual dose is 4-7
grams (1 rounded teaspoonful), 1-3 times daily, in a glass of liquid followed by another
glass of liquid.
Section VI. ANTIDIARRHEALS
2-32. KAOLIN MIXTURE WITH PECTIN
Kaolin is an adsorbent; pectin is considered a protective. Pectin is capable of
creating a viscous colloidal solution in water. Kaolin mixture with pectin may provide
relief from mild diarrhea, especially among children. However, it is of little use in severe
diarrhea such as that associated with ulcerative colitis. The usual adult dose is 4 to 8
tablespoons after each loose bowel movement.