From the Guidelines
Constipation treatment should prioritize a stimulant laxative or a heaping tablespoon (17 g) of polyethylene glycol with 8 oz of water 2 times daily, along with maintaining adequate fluid intake, as recommended by the NCCN Guidelines for Adult Cancer Pain Panel Members 1.
Treatment Options
When considering treatment options for constipation, it's essential to assess the cause and severity of constipation to rule out obstruction. The following options can be considered:
- Lifestyle changes, such as increasing dietary fiber and staying hydrated, can often resolve mild constipation.
- Over-the-counter options, including bulk-forming laxatives, osmotic laxatives, or stimulant laxatives for short-term use, can be effective.
- For chronic constipation, prescription medications like lubiprostone, linaclotide, or plecanatide may be needed.
Medication Considerations
According to the NCCN Guidelines, docusate has not shown benefit and is therefore not recommended 1. Additionally, supplemental medicinal fiber, such as psyllium, is ineffective and may worsen constipation.
Practical Considerations
Establishing a regular bathroom routine, responding promptly to the urge to defecate, and avoiding excessive use of stimulant laxatives are important practical considerations. Severe or persistent constipation should be evaluated by a healthcare provider to rule out underlying conditions.
Additional Interventions
In cases where constipation persists, other interventions, such as opioid rotation, enemas, or peripherally acting mu opioid receptor antagonists, may be considered 1. However, these options should be used under the guidance of a healthcare provider, as they may have potential risks and limitations.
From the FDA Drug Label
Uses for relief of occasional constipation (irregularity). This product generally produces bowel movement in 12 to 72 hours. Stop use and ask a doctor if • constipation lasts more than 7 days • rectal bleeding occurs • you fail to have a bowel movement These may be signs of a serious condition.
The treatment options for constipation include:
- Psyllium (PO): for relief of occasional constipation, producing a bowel movement in 12 to 72 hours 2
- It is recommended to stop use and ask a doctor if constipation lasts more than 7 days or if rectal bleeding occurs 2
- Polyethylene glycol (PO) should be used with caution, and users should stop and ask a doctor if they experience rectal bleeding, worsening nausea, bloating, cramping, or abdominal pain, or if they get diarrhea 3
From the Research
Treatment Options for Constipation
The treatment options for constipation can be categorized into several types, including:
- Dietary changes: increasing fiber intake and fluid consumption 4, 5
- Medications:
- Biofeedback therapy: for defecatory disorders 6, 7
- Surgery: in severe cases of slow-transit constipation 6, 7
Dietary Fiber Supplementation
Dietary fiber supplementation has been shown to be effective in improving symptoms of constipation, with psyllium and pectin having significant effects 5. A daily fiber intake of 25g can increase stool frequency, and this effect can be enhanced by increasing fluid intake to 1.5-2.0 liters/day 4.
Over-the-Counter Therapies
Over-the-counter therapies, such as polyethylene glycol, senna, and psyllium, have been found to be effective in treating chronic constipation, with good evidence supporting their use 8. However, the quality of evidence for other products, such as polydextrose, inulin, and fructo-oligosaccharide, is insufficient 8.
Management of Chronic Constipation
The management of chronic constipation should begin with dietary fiber supplementation and stimulant and/or osmotic laxatives, as appropriate, followed by intestinal secretagogues and/or prokinetic agents if necessary 7. Anorectal tests and colonic transit studies can help identify underlying pathogenic mechanisms and guide treatment 7.