The best stool softeners for hemorrhoids

A stool softener is a short bridge when a hard bowel movement would hurt. Hemorrhoids flare when you strain, so a softer stool for a few days can take the pressure off. The medicine in both softeners on this page is docusate. It is not the option with the best trial for softening stool. In a head-to-head study, psyllium did more.

Use Colace Clear if you want the small, dye-free softgels people take after birth or surgery. Use the Kirkland bottle if you want the same kind of medicine in a much larger count and you will follow its own dose, which is higher per softgel. Use Metamucil psyllium capsules if you can swallow several pills with water and you want the fiber that beat docusate, and that also has hemorrhoid trials behind it.

Which of the three fits which problem is spelled out in stool softener, fiber, or laxative. A softener does not fix a hemorrhoid that is already bleeding heavily. It only changes the stool you pass while you heal.

What a stool softener does, and what it does not

MedlinePlus drug information on docusate says stool softeners are for short-term constipation in people who should avoid straining, and it names hemorrhoids as one of those reasons. They work by softening the stool so it is easier to pass. Capsules are usually taken at bedtime with a full glass of water. One to three days of regular use are typically needed before they take effect. Do not take them for more than a week unless a doctor tells you to. If your bowel pattern has been different for more than two weeks, or the stool is still hard after a week, call a doctor ¹.

That is a narrower job than a fiber supplement. The NIDDK hemorrhoid treatment page lists both: a stool softener or a fiber supplement such as psyllium, plus fluids, less straining, and shorter sits on the toilet ⁹. Family physicians put stool softeners in the same first basket as fiber, water, sitz baths, and store creams ¹³. The trials, below, are why we still point most people toward fiber once the first week is over.

Docusate is not a stimulant laxative. It does not make the bowel squeeze. Listings sometimes blur that line. The drug page does not. If you need a push rather than a softer stool, that is a different medicine, and the NHS piles page suggests asking a pharmacist about laxatives when constipation is the driver ¹². Codeine painkillers can cause constipation, so they are a poor match during a flare-up ¹².

Our picks compared

Two docusate bottles for a short course, and one psyllium capsule for the plan that should outlast them.

Reviews of our picks

The awards follow the job. Colace Clear is the short, dye-free course. Kirkland is the same medicine when you want a large bottle. Metamucil capsules are the fiber alternative the trial supports.

How we chose these stool softeners for hemorrhoids

We looked for listings with strong overall ratings from a large number of buyers, then read recent reviews for the comments that repeat. For Colace Clear, that was relief without cramps, use after birth and surgery, dye-free softgels that are easy to swallow, and frustration with a small bottle. For Kirkland, it was a gentle effect people compared with the name brand, a large count, softgels that stick together, and cramps in a smaller share of buyers. We did not treat “works like the name brand” as a trial result. The trial result is the McRorie study in the next section, and it favors psyllium over docusate. Metamucil capsules are here for that reason, and because buyers who will not drink fiber powder still need a psyllium option. Their repeating complaints are the number of capsules per dose and stomach pain when the water is lacking.

What the research says

Psyllium versus docusate

The cleanest comparison is a randomized, double-blind trial in 170 adults with chronic constipation. After a 2-week placebo run-in, one group took psyllium 5.1 grams twice a day and the other took docusate sodium 100 milligrams twice a day, for 2 weeks. Psyllium raised stool water content more (an increase of 2.33 percent versus 0.01 percent on docusate). Stool water weight, total stool output, and a combined constipation score also favored psyllium. In the second treatment week, people on psyllium had 3.5 bowel movements, versus 2.9 on docusate. Week 1 was similar between the groups. The authors’ conclusion was that psyllium is better at softening stool, by putting more water in it, and is the stronger laxative of the two for this kind of constipation ².

That trial was not a hemorrhoid trial. It is still the right evidence for the claim printed on softener boxes, that the pill softens stool. On that claim, psyllium won.

Hemorrhoid trials of fiber point the same direction. A meta-analysis of seven randomized trials, 378 people, found fiber lowered the risk of symptoms that failed to improve (relative risk 0.53) and cut the risk of bleeding by about half (relative risk 0.50). Pain and itching were too uncertain to call. Follow-up in those studies was often at 6 weeks and at 3 months ³. A later constipation meta-analysis of 16 trials and 1,251 adults found fiber, including psyllium, helped more people than control (66 percent versus 41 percent responded), especially above 10 grams a day and when treatment lasted at least 4 weeks. Gas was more common on fiber ⁴. A US trial using 12 grams of psyllium a day for 4 weeks found less straining ¹¹.

Those docusate studies are in hospice and chronic illness, not in people buying a softener for a hemorrhoid flare-up. They do not prove docusate never helps. They do explain why we will not call it the best long-term pill for hemorrhoids. Fiber has the hemorrhoid meta-analysis. Docusate has a short-term role when you need something gentle for a few days and you accept that the softening data favor psyllium.

Water still matters if you choose fiber. In 117 adults eating about 25 grams of fiber a day, the group drinking about 2 liters of fluid had more frequent stools than the group drinking about 1 liter ¹⁰. A capsule without that water is how fiber gets blamed for pain.

Pregnancy and the weeks after birth

A Cochrane review of constipation treatments in pregnancy found no usable data on stool softeners. The comparisons that did exist were small. Fiber supplementation, in one study of 40 women, increased stool frequency by a mean of 2.24 times per week compared with no intervention. Stimulant laxatives improved constipation more than bulk-forming laxatives in one study of 140 women, and they also brought more abdominal discomfort and more diarrhea. The authors said the whole evidence base was too small for a firm ranking ⁷.

A clinical Q&A on hemorrhoids in pregnancy, not a trial, lists the usual first steps as more fiber, a stool softener, more fluid, and better toilet habits. It also says symptoms often settle after birth ⁸. ACOG tells pregnant patients that fiber and fluids help prevent hemorrhoids, and to call if symptoms do not ease ¹⁵. MedlinePlus says to tell your doctor if you are pregnant or breastfeeding before you take a stool softener ¹.

So the practical line is: many clinicians do use a softener after delivery and in late pregnancy, buyer reviews of Colace are full of that use, and the controlled evidence in pregnancy is about fiber, not about docusate. Ask the obstetric provider, then follow the one-week limit unless they say otherwise. More on those weeks is in postpartum hemorrhoids and hemorrhoids during pregnancy.

How to choose

Colace Clear is 50 milligrams of docusate sodium per softgel, in a 28-count bottle. Buyers like that it does not cramp and that the gels are small and free of dye. The complaint is how fast a small bottle runs out. For a one-week course, a small bottle is actually the right amount. It is a poor fit if you were planning to take a softener every day for months.

Kirkland softgels are 100 milligrams each, in a 400-count bottle. That is a different strength from Colace Clear. Taking “the same number of pills” from the two bottles is not the same dose. Buyers say it works like the name brand and is gentle. A minority report stomach pain, nausea, or cramps. Softgels that weld together in the bottle are a recurring annoyance. If the gels are stuck, do not chew them to get them apart. MedlinePlus says to swallow docusate capsules whole ¹.

Metamucil capsules are the fiber alternative. They are psyllium, not docusate. Buyers pick them because the drink is gritty and the capsules are not. You will take several capsules for a full dose. Stomach pain shows up when the water is missing. If capsules are a bad swallow for you, use a powder from the best fiber supplements instead. Flavonoid vein supplements are a separate question, covered on the hemorrhoid pills page. They do not soften stool.

Skip a stool softener, and ask a pharmacist, if you already take mineral oil. The drug page flags that combination ¹. Skip raising the dose because day 1 did nothing. The clock is 1 to 3 days ¹.

How to use them safely

1. Read the dose on your bottle. Colace Clear and Kirkland are not the same milligrams per softgel.
2. Take the softener at bedtime with a full glass of water, unless the label says otherwise ¹.
3. Wait 1 to 3 days before you judge it. Keep your fluid intake up on those days.
4. Stop at 7 days unless a doctor has told you to continue. If the stool is still hard, call rather than doubling ¹.
5. If you get cramps, a rash, vomiting, or trouble breathing, stop. Rash, hives, breathing trouble, fever, vomiting, and stomach pain are reasons MedlinePlus says to call a doctor right away ¹.
6. Start fiber during that same week if you can, so you are not left with nothing when the softener stops. Use the fiber calculator if you do not know where your diet stands, and see the hemorrhoid diet for foods that carry the grams.

While the stool is softening, keep toilet time short and do not strain. Those habits do as much as the pill for the next flare-up. They are covered in toilet habits that help hemorrhoids and in how to prevent hemorrhoids. If you need relief tonight, before the softener has had its 1 to 3 days, use the soak and the other steps in how to get rid of hemorrhoids fast. The wider menu, from home care to procedures, is on the hemorrhoid treatment page.

When to see a doctor instead

A softener is for hard stool and straining. It is not a test for the cause of bleeding.

Screening for colorectal cancer is recommended from age 45, so rectal bleeding in that range needs an exam, not another bottle ¹⁴. NIDDK says to seek care right away for severe anal pain and rectal bleeding, especially with belly pain, diarrhea, or fever ⁹. A change in bowel habits lasting more than two weeks is also on the docusate drug page as a reason to call ¹. What happens at the visit is in when to see a doctor for hemorrhoids.