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Invited Commentary
Less Is More
August 2016

Habitual Prescribing of Laxatives—It’s Time to Flush Outdated Protocols Down the Drain

Author Affiliations
  • 1Department of Medicine, University of California, San Francisco
  • 2Division of Geriatrics, Department of Medicine, University of California, San Francisco
  • 3Department of Veterans Affairs Medical Center, San Francisco, California
JAMA Intern Med. 2016;176(8):1217-1219. doi:10.1001/jamainternmed.2016.2780

Constipation is a common and distressing symptom among those who are ill. In addition to adequate fluid intake and mobilization, the mainstay of constipation treatment has traditionally been the “bowel regimen,” a stimulant laxative such as sennosides combined with the stool softener docusate. Years ago, as trainees fatigued by endless pages alerting us to constipated patients, we too routinely ordered sennosides and docusate for every patient admitted to the hospital. Only after tasting various laxatives—and memorably, gagging on liquid docusate—did we feel compelled to change this practice. There is now evidence demonstrating that docusate is ineffective for the treatment of constipation.1 It is time to stop a habitual practice that is wasteful and harmful to patients.

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