What treatment is recommended for constipation lasting 1 week?

Treatment for Constipation Lasting 1 Week

For constipation lasting 1 week, polyethylene glycol (PEG) is recommended as first-line pharmacological treatment due to its proven efficacy in increasing bowel movements and providing global symptom relief. 1

Initial Approach

Non-pharmacological interventions:

• Increase fluid intake, particularly for those with low fluid consumption 1
• Increase dietary fiber if patient has adequate fluid intake and physical activity 1
• Exercise, if appropriate for the patient's condition 1

First-line pharmacological treatment:

• Polyethylene glycol (PEG): 17g mixed in 8 ounces of water once daily 1
  • Has moderate certainty of evidence supporting its use
  • Increases complete spontaneous bowel movements by approximately 2.9 per week
  • Provides global relief of symptoms in a significant proportion of patients
  • Side effects include abdominal distension, loose stool, flatulence, and nausea

Alternative or Additional Treatments

If PEG is unavailable or ineffective:

• Fiber supplements: Psyllium is the most effective fiber supplement 1

  • Take with 8-10 ounces of fluid
  • Most effective for mild constipation
  • Can be used before PEG or in combination with PEG
  • Side effect: flatulence

• Stimulant laxatives: Bisacodyl 10-15 mg daily to three times daily 1

  • Goal: one non-forced bowel movement every 1-2 days
  • Good option for occasional use or rescue therapy
  • FDA warning: Should not be used for longer than one week without medical supervision 2

• Osmotic laxatives (if above options fail): 1

  • Magnesium hydroxide: 30-60 mL daily to twice daily
  • Magnesium citrate: 8 oz daily
  • Lactulose: 30-60 mL two to four times daily
  • Sorbitol: 30 mL every 2 hours × 3, then as needed
  • Note: Avoid magnesium products in patients with renal insufficiency 1

For Persistent Constipation

If constipation persists despite above measures:

• Rule out impaction, especially if diarrhea accompanies constipation (overflow around impaction) 1
• Rule out obstruction (physical exam, abdominal x-ray) 1
• Consider glycerine suppository with or without mineral oil retention enema 1
• Bisacodyl suppository: one rectally daily to twice daily 1
• Tap water enema until clear (for impaction) 1

Special Considerations

Important clinical pitfalls to avoid:

• Avoid excessive use of stimulant laxatives as they should not be used for more than one week without medical supervision 1, 2
• Avoid fiber supplements alone for moderate to severe constipation as they are unlikely to be sufficient 3, 4
• Avoid magnesium-based products in patients with renal insufficiency due to risk of hypermagnesemia 1
• Ensure adequate hydration when using fiber supplements to prevent worsening of constipation 1

Treatment algorithm:

1. Start with PEG 17g daily mixed in 8 oz water 1
2. If insufficient response after 2-3 days, add a stimulant laxative (bisacodyl) 1
3. If still inadequate response, consider suppositories or enemas 1
4. For impaction: manual disimpaction may be required following pre-medication with analgesic 1

The evidence strongly supports PEG as the most effective pharmacological treatment for constipation, with multiple randomized controlled trials demonstrating its efficacy and safety for both short-term and long-term use (up to 6 months) 1.