From the Guidelines
The initial management for a patient with constipation should involve a gradual increase in fiber intake and the use of an inexpensive osmotic agent, such as milk of magnesia or polyethylene glycol, as recommended by the American Gastroenterological Association 1. The goal is to soften the stool and increase its bulk, making it easier to pass.
- A gradual increase in fiber intake can be achieved through dietary changes, including eating more fruits, vegetables, and whole grains, as well as taking fiber supplements.
- Osmotic agents, such as polyethylene glycol 17 g daily or milk of magnesia 1 oz twice daily, can help draw water into the intestines, softening the stool and making it easier to pass 1.
- If symptoms do not respond to these initial treatments, a stimulant laxative, such as bisacodyl or glycerol suppositories, can be added to the treatment regimen, preferably administered 30 minutes after a meal to synergize with the gastrocolonic response 1.
- It is also important to establish a consistent bowel routine, including regular physical activity and adequate hydration, to help stimulate bowel movements.
- Biofeedback therapy may also be considered for patients with defecatory disorders, as it has been shown to improve symptoms in more than 70% of patients 1.
- Newer agents, such as lubiprostone and linaclotide, may be considered if symptoms do not respond to initial treatments, although their daily costs are significantly higher than those of traditional agents 1.
From the FDA Drug Label
USE • relieves occasional constipation (irregularity) • generally produces a bowel movement in 1 to 3 days Uses Relieves occasional constipation (irregularity) Generally causes bowel movement in 6 to 12 hours
The initial management for a patient with constipation can include the use of polyethylene glycol (PO) or senna (PO).
- Polyethylene glycol (PO) 2 can be used to relieve occasional constipation and generally produces a bowel movement in 1 to 3 days.
- Senna (PO) 3 can also be used to relieve occasional constipation and generally causes a bowel movement in 6 to 12 hours.
From the Research
Initial Management for Constipation
The initial management for a patient with constipation involves a combination of non-pharmacological and pharmacological interventions.
- The treatment options for fecal impaction, a common complication of constipation, include manual disimpaction or fragmentation, the use of distal and/or proximal softening or washout procedures such as enemas and suppositories, and oral or nasogastric tube placement for the administration of polyethylene glycol solutions containing electrolytes 4.
- Polyethylene glycol (PEG) with or without electrolytes is more efficacious than placebo for the treatment of functional constipation, either in adults or in pediatric patients, with great safety and tolerability 5.
- PEG is as efficacious as enemas in fecal impaction, avoids the need for hospital admission, and is well tolerated by patients, mainly when administered without electrolytes 5.
Treatment Options
The treatment options for constipation can be summarized as follows:
- Manual disimpaction or fragmentation 4
- Enemas and suppositories 4, 6
- Oral or nasogastric tube placement for the administration of polyethylene glycol solutions containing electrolytes 4, 5
- Polyethylene glycol (PEG) with or without electrolytes 5
Evaluation and Prevention
Post-treatment evaluation should include a colonic evaluation by flexible sigmoidoscopy, a colonoscopy, or a barium enema after the fecal impaction resolves 4.
- Following treatment, an evaluation of causes and creation of a preventive therapy plan is necessary 4.