From the Guidelines
Severe constipation should be treated with a multi-step approach, starting with lifestyle changes and progressing to medications if needed, with polyethylene glycol (PEG) being a recommended initial pharmacological treatment 1. The treatment of severe constipation involves a combination of lifestyle modifications and pharmacological interventions. Lifestyle changes include increasing fluid intake to 8-10 glasses of water daily and consuming more fiber-rich foods like fruits, vegetables, and whole grains, aiming for 25-30 grams of fiber daily. Regular physical activity also helps stimulate bowel movements.
- Key lifestyle changes:
- Increase fluid intake
- Increase dietary fiber
- Regular physical activity For immediate relief, over-the-counter osmotic laxatives like polyethylene glycol (MiraLAX, 17g dissolved in 8oz water daily) or stimulant laxatives such as bisacodyl (Dulcolax, 5-10mg orally) can be effective, as supported by recent guidelines 1.
- Initial pharmacological treatments:
- Polyethylene glycol (PEG)
- Stimulant laxatives (e.g., bisacodyl) Stool softeners like docusate sodium (Colace, 100mg twice daily) may help if stools are hard. For severe cases, a glycerin suppository or Fleet enema can provide quick relief. If constipation persists beyond two weeks despite these measures, consult a healthcare provider, as prescription medications like lubiprostone (Amitiza), linaclotide (Linzess), or plecanatide (Trulance) may be necessary, as recommended by the American Gastroenterological Association and the American College of Gastroenterology 1.
- Additional treatments for persistent constipation:
- Lubiprostone (Amitiza)
- Linaclotide (Linzess)
- Plecanatide (Trulance)
From the FDA Drug Label
1 INDICATIONS AND USAGE 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 severe constipation is linaclotide (PO), which is indicated for the treatment of chronic idiopathic constipation (CIC) in adults and functional constipation (FC) in pediatric patients 6 to 17 years of age 2.
- Key benefits of linaclotide include improvements in:
- CSBM frequency
- Stool consistency
- Amount of straining with bowel movements 2
From the Research
Treatment Options for Severe Constipation
The treatment for severe constipation can vary depending on the underlying cause and the patient's response to initial therapies. Some of the treatment options include:
- Lifestyle modifications, such as increased fiber and fluid intake 3, 4, 5
- Medications, such as polyethylene glycol, sodium picosulfate, bisacodyl, prucalopride, lubiprostone, and linaclotide 4
- Biofeedback therapy and pelvic muscle re-education for patients with dyssynergic defecation 3
- Dietary monitoring and modifications, fiber therapy, and education regarding self-monitoring and self-care for patients with constipation-predominant irritable bowel syndrome 3
Medication Therapy
Medication therapy for severe constipation can include:
- Bulk agents, such as psyllium, as first-line therapy 3, 5, 6
- Osmotic agents, such as polyethylene glycol, as second-line therapy 3, 5, 7, 6
- Stimulant laxatives, such as senna or bisacodyl, for occasional use 3, 7
- Other medications, such as lubiprostone and linaclotide, for patients who do not respond to other therapies 4
Combination Therapy
Combination therapy, such as the use of psyllium and polyethylene glycol, may be effective for some patients with severe constipation 5. However, the choice of therapy should be individualized based on the patient's specific needs and response to treatment.