From the Guidelines
Initial management of chronic constipation should focus on lifestyle modifications, including increasing dietary fiber intake to 20-30 grams daily and adequate hydration with 6-8 glasses of water daily, as well as regular physical activity and establishing a consistent bowel routine, before advancing to over-the-counter treatments or prescription medications. According to the American Gastroenterological Association and American College of Gastroenterology clinical practice guideline 1, nonpharmacological therapies, such as dietary recommendations and behavioral changes, are often the initial steps in management.
The guideline suggests the use of fiber supplementation, particularly psyllium, as a first-line therapy for chronic idiopathic constipation (CIC) 1. Patients can increase dietary fiber intake through fruits, vegetables, and whole grains, or with fiber supplements like psyllium (Metamucil) 1 tablespoon 1-3 times daily or methylcellulose (Citrucel) 1 tablespoon 1-3 times daily.
If these measures are insufficient, osmotic laxatives such as polyethylene glycol (MiraLAX) 17 grams daily can be added, as recommended by the guideline with a strong recommendation and moderate certainty of evidence 1. Stimulant laxatives like bisacodyl (Dulcolax) 5-10 mg daily or senna (Senokot) 8.6-17.2 mg at bedtime should be reserved for occasional use due to potential dependency concerns.
The guideline also recommends the use of secretagogues, such as linaclotide, for adults with CIC who do not respond to over-the-counter agents 1. However, the initial approach should prioritize lifestyle modifications and over-the-counter treatments before advancing to prescription medications, as supported by the guideline 1. If symptoms persist despite these measures for 2-4 weeks, patients should consult their healthcare provider for further evaluation and consideration of prescription medications.
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
The initial management recommendations for patients with chronic constipation are not explicitly stated in the provided drug label. However, it does indicate that linaclotide (PO) is used for the treatment of chronic idiopathic constipation (CIC) in adults 2.
- Key points:
- Linaclotide (PO) is indicated for CIC.
- The label does not provide information on initial management recommendations.
From the Research
Initial Management Recommendations for Chronic Constipation
The initial management recommendations for patients with chronic constipation include:
- Lifestyle modifications, such as scheduled toileting after meals, increased fluid intake, and increased dietary fiber intake 3
- A high-fiber diet, with a daily intake of 25 g of fiber, which can increase stool frequency in patients with chronic functional constipation 4
- Adequate fluid intake, with a daily intake of 1.5-2.0 liters of water, which can enhance the effect of a high-fiber diet on stool frequency and laxative consumption 4
- The use of fiber supplements, such as psyllium, which can help increase stool frequency and improve symptoms of constipation 3, 5
- The use of osmotic laxatives, such as polyethylene glycol, which can help increase the volume of intestinal contents and facilitate transport and evacuation 3, 5
Role of Occupational Therapist
The role of an occupational therapist in the management of chronic constipation is not explicitly stated in the provided studies. However, occupational therapists may play a role in helping patients with chronic constipation to develop strategies to manage their symptoms and improve their quality of life.
Dietary Recommendations
Dietary recommendations for patients with chronic constipation include:
- Increasing dietary fiber intake, with a focus on soluble fibers such as psyllium 5
- Increasing fluid intake, with a daily intake of 1.5-2.0 liters of water 4
- Avoiding foods that can exacerbate constipation, such as foods high in sugar and fat 6
- Eating a balanced diet that includes a variety of fruits, vegetables, and whole grains 6