From the Guidelines
Chronic constipation can be effectively managed through a combination of lifestyle changes and medications, with the most recent guidelines from the American Gastroenterological Association and the American College of Gastroenterology recommending a stepped approach to treatment 1.
Lifestyle Changes
To manage chronic constipation, patients should start by increasing their fiber intake to 25-30 grams daily through fruits, vegetables, and whole grains, or with supplements like psyllium (Metamucil) or methylcellulose (Citrucel) at 1-2 tablespoons daily mixed with water 1. Additionally, drinking 6-8 glasses of water daily and engaging in regular physical activity for at least 30 minutes most days can help alleviate constipation symptoms. Establishing a regular bathroom routine, particularly after meals when the gastrocolic reflex is strongest, can also be beneficial.
Medications
If lifestyle changes are insufficient, over-the-counter osmotic laxatives like polyethylene glycol (MiraLAX, 17g daily) or magnesium hydroxide (Milk of Magnesia, 30-60ml daily) can help draw water into the bowel 1. Stimulant laxatives such as bisacodyl (Dulcolax, 5-10mg) or senna (Senokot, 1-2 tablets) should be used sparingly for short-term relief due to the risk of side effects and dependence 1. For persistent constipation, prescription medications like lubiprostone (Amitiza, 24mcg twice daily) may be necessary, as it has been shown to increase intestinal fluid secretion and motility 1.
Key Considerations
When managing chronic constipation, it is essential to address the underlying cause, which may include slow colonic transit or pelvic floor dysfunction 1. The choice of medication should be guided by the patient's symptoms, medical history, and potential side effects, with a focus on minimizing harm and optimizing quality of life. The American Gastroenterological Association and the American College of Gastroenterology recommend a personalized approach to treatment, taking into account the individual patient's needs and preferences 1.
From the FDA Drug Label
The efficacy of LINZESS for the treatment of CIC was established in two double-blind, placebo-controlled, randomized, multicenter clinical trials in adult patients (Trials 3 and 4) A total of 642 patients in Trial 3 and 630 patients in Trial 4 [overall mean age of 48 years (range 18 to 85 years), 89% female, 76% white, 22% black, 10% Hispanic] received treatment with LINZESS 145 mcg, 290 mcg, or placebo once daily and were evaluated for efficacy. The CSBM responder rates are shown in Table 6 During the individual double-blind placebo-controlled trials, LINZESS 290 mcg did not consistently offer additional clinically meaningful treatment benefit over placebo than that observed with the LINZESS 145 mcg dose. Therefore, the 145 mcg dose is the recommended dose. In Trials 3 and 4, the proportion of patients who were CSBM responders was statistically significantly greater with the LINZESS 145 mcg dose than with placebo CSBM frequency reached maximum level during week 1 and was also demonstrated over the remainder of the 12-week treatment period in Trial 3 and Trial 4. For the mean change from baseline in CSBM frequency at week 12, the difference between placebo and LINZESS was approximately 1.5 CSBMs.
Linaclotide (LINZESS) is effective for the treatment of Chronic Idiopathic Constipation (CIC) in adults, with a recommended dose of 145 mcg once daily.
- The treatment has been shown to increase CSBM frequency and improve stool consistency and straining with bowel movements.
- Key benefits of linaclotide include:
- Increased CSBM frequency
- Improved stool consistency
- Reduced straining with bowel movements
- Rapid onset of action, with maximum CSBM frequency reached during week 1 2
1 INDICATIONS AND USAGE
1.1 Chronic Idiopathic Constipation in Adults Lubiprostone is indicated for the treatment of chronic idiopathic constipation (CIC) in adults.
Lubiprostone is also indicated for the treatment of Chronic Idiopathic Constipation (CIC) in adults 3.
From the Research
Treatment Options for Chronic Constipation
- Lifestyle modifications, such as increased exercise and fluid intake, are generally recommended as first-line approaches 4
- Dietary changes, including increased intake of fiber and water, are suggested by most health professionals 5, 6
- Fiber, particularly soluble fibers like psyllium, can be beneficial in managing chronic constipation 5, 6
- Mineral water, rich in magnesium and/or bicarbonate, may also be useful 5
Pharmacological Agents
- Osmotic laxatives, such as polyethylene glycol (PEG) and lactulose, have been shown to be effective in treating chronic constipation 4, 7, 6, 8
- Stimulant laxatives, like senna or bisacodyl, may be used as subsequent treatments if fiber is not successful or tolerated 7
- Newer agents, such as tegaserod and lubiprostone, have been approved for the treatment of chronic constipation 4
- Secretagogues, bile acid transporter inhibitors, probiotics, prokinetics, and Kampo medicines are also available as medical therapy options 8