From the Guidelines
Constipation can be effectively treated through a combination of lifestyle changes and medications, with the most recent guidelines from the American Gastroenterological Association and the American College of Gastroenterology recommending the use of polyethylene glycol (PEG), secretagogues, or prokinetic agents for the pharmacological management of chronic idiopathic constipation 1. To manage constipation, it is essential to start with lifestyle changes, including increasing daily fiber intake to 25-30 grams through fruits, vegetables, and whole grains, and drinking 6-8 glasses of water daily. Regular physical activity also helps stimulate bowel movements. Some key points to consider when treating constipation include:
- Increasing fluid and physical activity to help stimulate bowel movements
- Using over-the-counter options such as osmotic laxatives like Miralax (polyethylene glycol) taken as 17g dissolved in water once daily, stimulant laxatives such as Dulcolax (bisacodyl) 5-10mg tablets, or stool softeners like Colace (docusate sodium) 100mg twice daily
- Considering fiber supplements such as Metamucil (psyllium) 1 tablespoon mixed in water 1-3 times daily
- For severe cases, prescription medications like Linzess (linaclotide) or Amitiza (lubiprostone) may be necessary, as recommended by recent studies 1 It is crucial to note that if constipation persists beyond two weeks, is accompanied by severe pain, bleeding, or weight loss, or if you're over 50 with new-onset constipation, consulting a healthcare provider is necessary, as these could indicate more serious conditions. The use of newer agents such as linaclotide and lubiprostone has been shown to be effective in treating constipation, with linaclotide acting as a selective agonist of guanylate cyclase-C receptors in the intestines to enhance intestinal secretions, and lubiprostone acting as an orally active prostaglandin analog to enhance intestinal fluid secretion 1. Overall, the treatment of constipation should be tailored to the individual patient's needs, taking into account the underlying cause of constipation, as well as any underlying medical conditions or medications that may be contributing to constipation.
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 total of 642 patients in Trial 3 and 630 patients in Trial 4 [overall mean age of 48 years (range 18 to 85 years), 89% female, 76% white, 22% black, 10% Hispanic] received treatment with LINZESS 145 mcg, 290 mcg, or placebo once daily and were evaluated for efficacy. The CSBM responder rates are shown in Table 6 During the individual double-blind placebo-controlled trials, LINZESS 290 mcg did not consistently offer additional clinically meaningful treatment benefit over placebo than that observed with the LINZESS 145 mcg dose. Therefore, the 145 mcg dose is the recommended dose. 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 CSBM frequency reached maximum level during week 1 and was also demonstrated over the remainder of the 12-week treatment period in Trial 3 and Trial 4. For the mean change from baseline in CSBM frequency at week 12, the difference between placebo and LINZESS was approximately 1. 5 CSBMs. On average, patients who received LINZESS across the 2 trials had significantly greater improvements compared with patients receiving placebo in stool frequency (CSBMs/week and SBMs/week), and stool consistency (as measured by the BSFS) In each trial, in addition to improvements in CSBM frequency over the first 12 weeks of the treatment period, improvements were observed in each of the following when LINZESS was compared to placebo: SBM frequency [SBMs/week], stool consistency [as measured by the BSFS], and amount of straining with bowel movements [amount of time pushing or physical effort to pass stool]
Linaclotide (LINZESS) is effective for the treatment of constipation.
- The recommended dose is 145 mcg once daily.
- Key benefits of linaclotide include:
- Increased stool frequency
- Improved stool consistency
- Reduced straining with bowel movements
- Clinical trials have shown that linaclotide is effective in treating constipation, with significant improvements in CSBM frequency and stool consistency compared to placebo 2.
- Linaclotide is indicated for the treatment of chronic idiopathic constipation (CIC) in adults 2.
From the Research
Treatment Options for Constipation
- Lifestyle modifications and increased intake of fiber and water are suggested by most health professionals as the first line of treatment for constipation 3, 4
- A well-designed diet that includes fiber, particularly soluble fibers such as psyllium, can be an effective tool in managing chronic constipation 5, 6
- Polyethylene glycol (PEG) or macrogol, an inert non-absorbable molecule, can also be used to increase the volume of intestinal contents and facilitate transport and evacuation 5, 7
- Other treatment options include stimulants such as bisacodyl and sodium picosulfate, fiber, fruit-based laxatives, and magnesium oxide, although the evidence supporting their use is modest 7
Dietary Recommendations
- Increasing fiber intake, particularly with soluble fibers such as psyllium and pectin, can improve symptoms of constipation 6
- Higher fiber doses (>10g/d) and longer treatment durations (≥4 weeks) appear to be more effective in improving constipation symptoms 6
- Adequate fluid intake, particularly mineral water rich in magnesium and/or bicarbonate, can also be beneficial in managing constipation 3