What is the treatment for severe constipation?

From the Guidelines

Severe constipation should be treated with polyethylene glycol (PEG) as the first-line medication, at a dose of 17g powder dissolved in 8oz water daily, as it has been shown to be effective in multiple randomized, placebo-controlled trials 1. The treatment of severe constipation involves a combination of lifestyle changes and medications. Increasing fluid intake to at least 8 glasses of water daily and adding more fiber to the diet through fruits, vegetables, and whole grains can help alleviate symptoms.

Medication Options

• Over-the-counter osmotic laxatives like PEG (MiraLAX) can provide relief within 24-48 hours.
• Stimulant laxatives such as bisacodyl (Dulcolax) can be used for immediate relief.
• For severe cases, prescription medications like lubiprostone (Amitiza) or linaclotide (Linzess) may be necessary. Regular physical activity can also help stimulate bowel movements.

When to Seek Medical Attention

Severe constipation can indicate underlying health issues, so it is essential to consult a healthcare provider if symptoms persist beyond two weeks, are accompanied by bleeding, weight loss, or severe pain, or if there is a family history of colon cancer or inflammatory bowel disease. According to the american gastroenterological association-american college of gastroenterology clinical practice guideline, PEG has been studied in multiple randomized, placebo-controlled trials, demonstrating its effectiveness in treating chronic idiopathic constipation 1. Additionally, the management of adult patients with severe chronic small intestinal dysmotility guidelines suggest that osmotic laxatives like PEG can increase the amount of water in the large bowel, helping to alleviate constipation symptoms 1.

From the FDA Drug Label

PATIENT INFORMATION Polyethylene Glycol 3350 NF (Polyethylene Glycol 3350 Powder for Oral Solution) is a prescription only laxative which has been prescribed by your physician to treat constipation. The dose is 17 grams each day or as directed by physician. Polyethylene Glycol 3350 NF softens the stool and increases the frequency of bowel movements by retaining water in the stool Your first bowel movement will usually happen in two to four days, although results may vary for individual patients. Polyethylene Glycol 3350 NF achieves its best results when used between one and two weeks.

The treatment for severe constipation is to take 17 grams of polyethylene glycol 3350 each day or as directed by a physician. The medication should be taken by mouth after being dissolved in 4 to 8 ounces of water, juice, soda, coffee, or tea. It is recommended to use the medication for 2 weeks or less, or as directed by a physician 2.

• Key points:
  • Take 17 grams of polyethylene glycol 3350 per day
  • Dissolve in 4 to 8 ounces of liquid
  • Use for 2 weeks or less, or as directed by a physician
  • May cause side effects such as nausea, stomach fullness, cramping, diarrhea, and/or gas 2
  • If unusual cramps, bloating, or diarrhea occur, consult a physician 2

From the Research

Treatment Options for Severe Constipation

• Lifestyle modifications and dietary therapies are the first line of treatment for severe constipation, including increasing fiber intake to at least 20-25g per day 3
• Medical therapy includes osmotic laxatives, such as polyethylene glycol 3350, which has been shown to be effective in treating chronic idiopathic constipation 4
• Stimulant laxatives, such as bisacodyl, can also be used to treat constipation, and have been shown to have similar efficacy to other laxatives 5
• Other treatment options include secretagogues, bile acid transporter inhibitors, probiotics, prokinetics, and Kampo medicines 6
• Temporary use of suppositories, enemas, and digital evacuation may also be recommended 6

Dietary Changes

• Increasing fiber intake through wholegrain carbohydrates, fruit, and vegetables can help prevent and manage constipation 7
• Adequate fluid intake is also important, although the evidence for increasing water intake as a treatment for constipation is limited 3
• A gradual increase in fiber intake is recommended to avoid side effects such as bloating and abdominal pain 3

Medications

• Polyethylene glycol 3350 has been shown to be effective in treating chronic idiopathic constipation, with significant improvements in complete spontaneous bowel movements and reductions in hard/lumpy stools and cramping 4
• Bisacodyl is a stimulant laxative that can be used to treat constipation, and has been shown to have similar efficacy to other laxatives 5
• Other medications, such as osmotic laxatives and secretagogues, may also be used to treat constipation, depending on the individual's symptoms and medical history 6