From the Guidelines
The treatment for constipation should start with lifestyle modifications and over-the-counter options, with polyethylene glycol (PEG) being a recommended osmotic laxative, as stated in the 2023 American Gastroenterological Association-American College of Gastroenterology clinical practice guideline 1.
Treatment Approach
The approach to treating constipation typically involves a step-wise progression from lifestyle modifications to over-the-counter medications and, if necessary, prescription medications.
- Lifestyle modifications include:
- Increased fluid intake (at least 8 glasses of water daily)
- Dietary changes to include more fiber (25-30g daily)
- Regular physical activity
- Over-the-counter options:
- Fiber supplements like psyllium (Metamucil) 1 teaspoon in water 1-3 times daily
- Stool softeners such as docusate sodium (Colace) 100mg twice daily
- Osmotic laxatives like polyethylene glycol (MiraLAX) 17g in water daily, as recommended by 1
- Stimulant laxatives such as bisacodyl (Dulcolax) 5-10mg orally or senna (Senokot) 8.6-17.2mg at bedtime for short-term use
Prescription Medications
For persistent constipation, prescription medications may include:
- Lubiprostone (Amitiza) 24mcg twice daily
- Linaclotide (Linzess) 145-290mcg daily
- Plecanatide (Trulance) 3mg daily These treatments work by increasing intestinal water content, stimulating bowel movements, or softening stool to facilitate passage, as discussed in 1.
Important Considerations
- Patients should start with the least invasive options and progress as needed, while addressing any underlying causes.
- Chronic use of stimulant laxatives should be avoided as they can lead to dependence.
- If constipation persists despite these measures, medical evaluation is recommended to rule out more serious conditions, as suggested by 1.
From the FDA Drug Label
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 for a patient with constipation is linaclotide (LINZESS), which is indicated for the treatment of chronic idiopathic constipation (CIC) in adults.
- The recommended dose is 145 mcg once daily.
- Linaclotide has been shown to increase the frequency of complete spontaneous bowel movements (CSBMs) and improve stool consistency and straining with bowel movements 2.
From the Research
Treatment Options for Constipation
- The treatment for constipation can be classified into several categories, including dietary changes, behavioral modifications, pharmacologic therapy, and surgical intervention 3.
- Increasing dietary fiber intake is a common approach to treating constipation, and can be achieved through dietary changes or fiber supplements 3, 4.
- Behavioral changes, such as laxation and toilet-training programs, can also be effective in managing constipation 3.
Dietary Changes
- Increasing dietary fiber intake can help improve stool frequency and consistency 4.
- A diet rich in fruits, vegetables, and whole grains can help promote regular bowel movements 3.
- Adequate fluid intake is also essential to prevent constipation 5, 6.
Pharmacologic Therapy
- Osmotic laxatives, such as polyethylene glycol, can be effective in treating constipation 5, 6, 7.
- Stimulant laxatives, such as senna, can also be used to treat constipation, but should be used with caution due to the risk of dependence 7.
- Fiber supplements, such as psyllium, can help improve stool frequency and consistency 4, 7.
Other Treatment Options
- Surgical intervention may be necessary in rare cases where constipation is caused by an underlying anatomical abnormality 3.
- Biofeedback therapy and pelvic floor physical therapy may also be effective in managing constipation 5.
- Peripherally acting mu-opioid antagonists can be effective in treating opioid-induced constipation, but are expensive 5.