From the Guidelines
Treatment for constipation should begin with lifestyle changes, including increasing fiber intake and fluid consumption, before moving to medications, as recommended by the most recent guidelines 1. The goal of treatment is to improve bowel movements, reduce symptoms, and enhance quality of life.
Lifestyle Changes
- Increasing fiber intake to 25-30 grams daily through fruits, vegetables, and whole grains helps add bulk to stool
- Drinking 6-8 glasses of water daily and regular physical activity also promote bowel movements
Medications
- Over-the-counter options include:
- Bulk-forming laxatives (Metamucil, Citrucel), which should be taken with plenty of water
- Osmotic laxatives (MiraLAX, magnesium citrate) that draw water into the intestines
- Stimulant laxatives (Dulcolax, Senna) for short-term use
- Stool softeners (Colace) that increase water absorption in the stool
- For chronic constipation, prescription medications like lubiprostone (Amitiza), linaclotide (Linzess), or plecanatide (Trulance) may be prescribed, as recommended by the American Gastroenterological Association 1 These medications work by increasing intestinal fluid secretion and accelerating transit time.
Severe Cases
Manual removal, enemas, or suppositories might be needed for severe cases. Constipation often results from slow movement of stool through the colon, allowing excessive water absorption that makes stool hard and difficult to pass. Addressing the underlying cause, whether it's medication side effects, dehydration, or a medical condition, is essential for effective treatment, as highlighted in the guidelines for managing irritable bowel syndrome 1 and palliative care 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 proportion of patients who were CSBM responders was statistically significantly greater with the LINZESS 145 mcg dose than with placebo Table 6: Efficacy Responder Rates in Two Placebo-Controlled Trials of Adults with CIC (Trials 3 and 4): At Least 9 Out of 12 Weeks 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. 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 treatment options for constipation include linaclotide (LINZESS), which 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 Key benefits of linaclotide include:
- Increased CSBM frequency
- Improved stool consistency
- Reduced straining with bowel movements 2 2
From the Research
Treatment Options for Constipation
The treatment options for constipation can be categorized into lifestyle modifications, dietary changes, and medical interventions.
- Lifestyle modifications: Scheduled toileting after meals, increased fluid intake, and increased dietary fiber intake are recommended as initial treatments for constipation 3, 4, 5.
- Dietary changes: Increasing fiber intake in the form of polycarbophil, methylcellulose, or psyllium may improve symptoms, and fiber intake should be slowly increased over several weeks to decrease adverse effects 3.
- Medical interventions:
- Osmotic laxatives: Polyethylene glycol is an example of an osmotic laxative that can be used to treat constipation 3, 5.
- Stimulant laxatives: Bisacodyl is an example of a stimulant laxative that can be used to treat constipation 5.
- Intestinal secretagogues: Lubiprostone is an example of an intestinal secretagogue that can be used to treat chronic idiopathic constipation and IBS-C 6.
- Prokinetic agents: Prucalopride is an example of a prokinetic agent that can be used to treat chronic idiopathic constipation 5.
- Peripherally acting μ-opiate antagonists: These agents can be used to treat opioid-induced constipation 3, 7.
Special Considerations
- Fecal impaction should be treated with mineral oil or warm water enemas 3.
- Long-term use of magnesium-based laxatives should be avoided due to potential toxicity 3.
- Biofeedback therapy can be used to treat defecatory disorders 7.
- Colonic transit and manometry can be used to evaluate colonic motility and identify colonic dysmotility 7.
- Colectomy may be necessary for slow-transit constipation in specific patients 7.