What are the treatment options for chronic constipation?

From the Guidelines

The most effective treatment for chronic constipation is a combination of lifestyle modifications and medications, starting with an increase in fiber intake to 25-30 grams daily and adequate hydration, as recommended by the American Gastroenterological Association 1.

Treatment Options

• Increase fiber intake to 25-30 grams daily through fruits, vegetables, and whole grains, or with supplements like psyllium (Metamucil) or methylcellulose (Citrucel) 1
• Drink 6-8 glasses of water daily and exercise regularly to stimulate bowel movements
• Over-the-counter options include:
  • Osmotic laxatives like polyethylene glycol (MiraLAX, 17g daily), which draws water into the bowel 1
  • Stimulant laxatives such as bisacodyl (Dulcolax, 5-10mg) or senna (Senokot, 8.6-17.2mg) for short-term use 1

Prescription Medications

• Lubiprostone (Amitiza, 24mcg twice daily), which increases intestinal fluid secretion and motility 1
• Linaclotide (Linzess, 145-290mcg daily) or plecanatide (Trulance, 3mg daily), which increase intestinal fluid secretion and motility

Important Considerations

• Dietary assessment is important to determine total fiber intake from diet and supplements 1
• Adequate hydration should be encouraged with the use of fiber 1
• Flatulence is a commonly observed side effect with the use of fiber 1
• Consult a healthcare provider if symptoms persist or worsen, especially if accompanied by weight loss, bleeding, or severe pain 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 CSBM responder in the CIC trials was defined as a patient who had at least 3 CSBMs and an increase of at least 1 CSBM from baseline in a given week for at least 9 weeks out of the 12-week treatment period. In Trials 3 and 4, the proportion of patients who were CSBM responders was statistically significantly greater with the LINZESS 145 mcg dose than with placebo

1 INDICATIONS AND USAGE

1.1 Chronic Idiopathic Constipation in Adults Lubiprostone is indicated for the treatment of chronic idiopathic constipation (CIC) in adults.

Treatment options for chronic constipation include:

• Linaclotide (LINZESS) 145 mcg once daily, which has been shown to increase the frequency of complete spontaneous bowel movements (CSBMs) and improve stool consistency and straining with bowel movements 2
• Lubiprostone, which is indicated for the treatment of chronic idiopathic constipation (CIC) in adults 3

From the Research

Treatment Options for Chronic Constipation

The treatment options for chronic constipation include:

• Lifestyle modifications and increased intake of fiber and water 4, 5
• Dietary changes, such as increasing fiber intake through diet or fiber supplements 6, 7
• Medications, including:
  • Bulk agents, such as psyllium 6
  • Osmotic laxatives, such as polyethylene glycol (PEG) or macrogol 6, 8
  • Stimulant laxatives, such as senna or bisacodyl 8
  • 5-hydroxytryptamine4 (5-HT4) agonists, such as tegaserod 7, 8
• Combination therapy, such as the combination of psyllium and PEG 6

Dietary Recommendations

Dietary recommendations for chronic constipation include:

• Increasing fiber intake to at least 20-25g per day 5
• Gradually adjusting fiber intake to avoid side effects such as bloating and abdominal pain 5
• Increasing water intake, although the evidence for this is limited 4, 5
• Considering the use of mineral water rich in magnesium and/or bicarbonate 4

Pharmacological Agents

Pharmacological agents for chronic constipation include:

• Polyethylene glycol (PEG) or macrogol, which has been shown to be effective with minimal side effects 6, 8
• Tegaserod, a selective 5-HT4 receptor partial agonist, which has been shown to be effective in patients younger than 65 years of age 7, 8
• Stimulant laxatives, such as senna or bisacodyl, which may be used in patients who do not respond to more conservative measures 8