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Q: I have been taking a daily stool softener to help my constipation. Is this safe? Is there some other over-the-counter product I can use safely?

A: Stool softeners such as docusate (Colace, Surfak, generic versions) are safe. However, when put to scientific testing in controlled clinical trials, they are no better at relieving constipation than a placebo.

Despite the studies, I'm sure some people do find that regular use of docusate softens their stools. But, there are plenty of other ways to accomplish the same thing.

The difference between a hard stool and a soft one is its water content. So you want to make sure you are drinking plenty of fluids and then add more fiber to your diet.

Increasing your fiber intake helps soften stool because fiber pulls water into the intestine. Many of us get only a small fraction of the 25 to 35 grams of fiber we're supposed to eat each day. Fruits, vegetables, and whole grains are good sources. Specific examples include Brussels sprouts, apples, figs, bran cereal, and black beans.

If you have trouble getting enough fiber from food, try adding a fiber-based bulk-forming agent like psyllium (Metamucil), methylcellulose (Citrucel), or polycarbophil (Fibercon). All forms of fiber can produce abdominal cramps, bloating, and flatulence, so it's best to increase your intake gradually. Start with small doses to allow your intestines to adjust.

If those strategies are not working well enough or the fiber products are causing too much gas, I usually recommend an osmotic agent such as polyethylene glycol (Miralax, generic versions). Osmotic agents pull water out of the large intestine, thereby adding more water to stool and making it easier to pass. As always, adequate fluid intake is a must.

Unless prescribed by your doctor, avoid daily use of stimulant laxative, like bisacodyl (Dulcolax, other brands) and senna (Senokot, other brands). They can lead to long-term dependency to keep the colon moving. Occasional use of a stimulant laxative once or twice a week is likely to be safe.

Don't rely only on medicines to stay regular. Here's what else you need to do:

--Be physically active and get regular exercise, such as a daily walk.

--Establish a good bowel routine. For example, even if you don't have the urge, take time after breakfast to head to the bathroom.

--Don't ignore your body's signals. Always try to "heed the call" and head for the bathroom whenever you feel the urge to move your bowels. The longer stool sits in your intestines, the harder it becomes, and the more difficult it is to push out.

(Howard LeWine, M.D., is an internist at Brigham and Women's Hospital in Boston and assistant professor at Harvard Medical School. For additional consumer health information, please visit www.health.harvard.edu.)

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