From the Guidelines
Treatment for constipation should start with lifestyle changes, including increasing fiber intake to 25-30 grams daily and drinking 6-8 glasses of water daily, along with regular physical activity, as recommended by the American Gastroenterological Association and the American College of Gastroenterology 1.
Initial Treatment Options
- Increase fiber intake through fruits, vegetables, and whole grains
- Drink 6-8 glasses of water daily
- Engage in regular physical activity
Over-the-Counter Medications
- Bulk-forming laxatives like psyllium (Metamucil, 1 teaspoon 1-3 times daily mixed with water)
- Osmotic laxatives such as polyethylene glycol (MiraLAX, 17g in 8oz water daily)
- Stimulant laxatives like bisacodyl (Dulcolax, 5-10mg tablets once daily)
Prescription Medications for Persistent Constipation
- Lubiprostone (Amitiza, 24mcg twice daily)
- Linaclotide (Linzess, 145-290mcg once daily)
- Plecanatide (Trulance, 3mg once daily) These medications work by increasing intestinal fluid secretion and motility, and should be considered after initial lifestyle changes and over-the-counter medications have been tried, as supported by recent guidelines 1.
Important Considerations
- If constipation persists beyond two weeks despite treatment, is accompanied by severe pain, bleeding, or weight loss, or if it represents a sudden change in bowel habits, medical evaluation is necessary to rule out underlying conditions.
- The use of docusate as a stool softener has not shown benefit and is not recommended for prophylaxis, according to the NCCN Guidelines for Adult Cancer Pain Panel Members 1.
From the FDA Drug Label
1 INDICATIONS AND USAGE LINZESS is indicated for the treatment of:
• irritable bowel syndrome with constipation (IBS-C) in adults • chronic idiopathic constipation (CIC) in adults • functional constipation (FC) in pediatric patients 6 to 17 years of age
Treatment options for constipation include:
- Linaclotide (PO) for the treatment of irritable bowel syndrome with constipation (IBS-C) in adults
- Linaclotide (PO) for the treatment of chronic idiopathic constipation (CIC) in adults
- Linaclotide (PO) for the treatment of functional constipation (FC) in pediatric patients 6 to 17 years of age 2 2
From the Research
Treatment Options for Constipation
- Lifestyle modifications and increased intake of fiber and water are suggested by most health professionals as the first line of treatment for constipation 3, 4, 5, 6.
- A high-fiber diet, particularly with soluble fibers such as psyllium, can help alleviate constipation symptoms 4, 5, 6.
- Adequate fluid intake, especially with mineral water rich in magnesium and/or bicarbonate, is also essential for preventing and managing constipation 3, 5, 6.
- Over-the-counter (OTC) therapies, such as polyethylene glycol (PEG), senna, and psyllium, have been shown to be effective in treating chronic constipation 7.
- Combination therapy, such as the use of psyllium and PEG, may also be beneficial for patients with chronic constipation 4.
- Dietary changes, including increased consumption of wholegrain carbohydrates, fruit, and vegetables, can also help prevent and manage constipation 6.
Specific Treatment Recommendations
- Polyethylene glycol (PEG) and senna are recommended as first-line laxatives for chronic constipation 7.
- Fiber supplements, such as psyllium, and fruits like kiwi, mango, prunes, and ficus, may also be effective in treating constipation 7.
- Magnesium-based products and stimulant laxatives, such as bisacodyl and sodium picosulfate, may also be used to treat constipation 7.
- Yogurt with galacto-oligosaccharide/prunes/linseed oil may also be beneficial for patients with constipation 7.