What are the guidelines for managing constipation?

From the Guidelines

Constipation management should start with lifestyle modifications, including increasing fiber intake to 25-30g daily and drinking 6-8 glasses of water daily, before moving to medications, as recommended by the most recent guidelines 1.

Stepwise Approach to Constipation Management

The management of constipation involves a stepwise approach, starting with non-pharmacological therapies and progressing to pharmacological treatments if necessary.

• Increase fiber intake to 25-30g daily through fruits, vegetables, and whole grains.
• Drink 6-8 glasses of water daily to help soften stool and increase intestinal water content.
• Regular physical activity helps stimulate bowel movements.

Pharmacological Management

When lifestyle changes are not sufficient, pharmacological treatment may be necessary.

• Start with osmotic laxatives like polyethylene glycol (MiraLAX, 17g in 8oz water daily) or magnesium citrate (200-300mg daily) to soften stool and increase intestinal water content.
• If needed, add stimulant laxatives such as senna (8.6-17.2mg daily) or bisacodyl (5-10mg daily) for short-term use to stimulate intestinal contractions.
• For more severe cases, prescription medications like lubiprostone (24mcg twice daily), linaclotide (145-290mcg daily), or plecanatide (3mg daily) may be necessary, as recommended by recent guidelines 1.

Additional Considerations

• Avoid straining during bowel movements and establish a regular bathroom routine, ideally 15-30 minutes after meals when the gastrocolic reflex is strongest.
• If constipation persists beyond two weeks despite these measures, or if accompanied by concerning symptoms like blood in stool or significant weight loss, medical evaluation is necessary, as emphasized by various studies 1.

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

2 DOSAGE AND ADMINISTRATION 2. 1 Recommended Dosage Irritable Bowel Syndrome with Constipation (IBS-C) in adults The recommended dosage of LINZESS is 290 mcg orally once daily. Chronic Idiopathic Constipation (CIC) in adults The recommended dosage of LINZESS is 145 mcg orally once daily. A dosage of 72 mcg once daily may be used based on individual presentation or tolerability Functional Constipation (FC) in pediatric patients 6 to 17 years of age The recommended dosage of LINZESS is 72 mcg orally once daily.

The constipation guidelines for LINZESS are as follows:

• For irritable bowel syndrome with constipation (IBS-C) in adults, the recommended dosage is 290 mcg orally once daily.
• For chronic idiopathic constipation (CIC) in adults, the recommended dosage is 145 mcg orally once daily, with an option to use 72 mcg once daily based on individual presentation or tolerability.
• For functional constipation (FC) in pediatric patients 6 to 17 years of age, the recommended dosage is 72 mcg orally once daily 2.

From the Research

Constipation Guidelines

• The management of constipation typically involves a combination of lifestyle modifications, dietary changes, and medication [(3,4,5,6)].
• Initial treatment options often include increasing dietary fiber and fluid intake, as well as lifestyle maneuvers such as scheduled toileting and physical activity [(4,5,6)].
• If initial treatments are not successful, subsequent options may include the use of osmotic laxatives, stimulants, and other medications [(3,4,5)].
• Polyethylene glycol is a commonly used and effective treatment for chronic constipation, and may be used as an initial or second-line agent [(3,4,5,7)].
• Biofeedback and surgical interventions may also be considered in certain cases, such as dyssynergic defecation or refractory constipation [(3,6)].
• In children with cerebral palsy, a high fiber diet may be a suitable alternative to polyethylene glycol for managing chronic constipation 7.
• The evaluation of constipation typically begins with a focused history and physical examination, and may involve additional diagnostic testing if alarm signs are present 6.
• Treatment should be tailored to the individual patient's needs and circumstances, taking into account factors such as age, medical history, and lifestyle [(5,6)].