From the Guidelines
Lupus patients experiencing constipation should be treated with polyethylene glycol, as it is a strongly recommended medication for chronic idiopathic constipation in adults, according to the American Gastroenterological Association-American College of Gastroenterology clinical practice guideline 1. To manage constipation in lupus patients, start with lifestyle modifications including increased water intake and more dietary fiber. If these measures aren't sufficient, consider over-the-counter medications like polyethylene glycol, which is a strongly recommended option 1. Other options, such as sodium picosulfate, linaclotide, plecanatide, and prucalopride, are also strongly recommended for chronic idiopathic constipation in adults 1. Some lupus medications can worsen constipation, so discuss medication adjustments with your healthcare provider. Persistent constipation warrants medical evaluation as it could indicate complications like intestinal pseudo-obstruction. Key considerations for managing constipation in lupus patients include:
- Increased water intake
- More dietary fiber
- Regular physical activity
- Polyethylene glycol as a first-line medication
- Avoiding long-term use of stimulant laxatives
- Medical evaluation for persistent constipation 1.
From the Research
Definition and Prevalence of Constipation
- Constipation is a common gastrointestinal motility disorder that can be chronic and negatively affect patients' daily lives 2.
- It is associated with high healthcare costs and can cause significant distress for patients, including symptoms such as straining and the sensation of incomplete bowel emptying 3.
Treatment Options for Constipation
- Nonpharmacologic modalities, such as increased exercise or fluid intake and bowel habit training, are generally recommended as first-line approaches 2.
- Dietary changes, including increased consumption of wholegrain carbohydrates, fruit, and vegetables, can also play a role in preventing and managing constipation 3.
- Fiber supplements, such as psyllium, and laxatives, such as polyethylene glycol, can be effective in treating constipation, especially when used in combination 4, 5.
- Newer agents, such as lubiprostone and linaclotide, have also been shown to be effective and safe in treating chronic constipation 2, 5, 6.
Management of Constipation in Specific Populations
- In patients with Parkinson's disease, constipation can be a frequent and debilitating symptom, and treatment options may include polyethylene glycol, lubiprostone, and nonpharmacological interventions such as biofeedback therapy 6.
- A multistep approach to management, favouring early introduction of combined therapies and long-term step-down strategy to the lowest satisfactory regimen, may be effective in managing constipation in various populations 5.