From the Guidelines
For acute constipation, the most effective treatment is the use of bisacodyl or sodium picosulfate (SPS) short term or as rescue therapy, as recommended by the American Gastroenterological Association and the American College of Gastroenterology 1. To manage acute constipation, it is essential to increase fluid intake to at least 8 glasses of water daily and add more fiber to the diet through fruits, vegetables, and whole grains. Physical activity, even a 15-30 minute walk, can stimulate bowel movements. Over-the-counter options include:
- Fiber supplements like psyllium (Metamucil) taken with plenty of water
- Stool softeners such as docusate sodium (Colace) at 100mg once or twice daily
- Osmotic laxatives like polyethylene glycol (Miralax) at 17g dissolved in 8oz of water daily For faster relief, stimulant laxatives such as bisacodyl (Dulcolax) at 5-10mg orally or senna (Senokot) at 8.6-17.2mg can work within 6-12 hours, as supported by studies 1. Glycerin suppositories or mineral oil enemas provide even quicker results. Establishing a regular bathroom routine, preferably after meals when the gastrocolic reflex is strongest, can also help. If constipation persists beyond a week, is accompanied by severe pain, bleeding, or occurs after starting new medications, seeking medical attention is crucial. The use of bisacodyl or sodium picosulfate (SPS) is recommended due to its strong recommendation and moderate certainty of evidence, as stated in the American Gastroenterological Association and the American College of Gastroenterology clinical practice guideline 1. This guideline prioritizes the use of these medications for the management of chronic idiopathic constipation, which can be applied to acute constipation as well.
From the FDA Drug Label
USE • relieves occasional constipation (irregularity) • generally produces a bowel movement in 1 to 3 days For treating acute constipation, polyethylene glycol (PO) can be used as it relieves occasional constipation. The expected outcome is a bowel movement in 1 to 3 days 2.
From the Research
Treatment Options for Acute Constipation
- Nonpharmacological and dietary changes are typically recommended as first-line treatment for most types of constipation 3
- Prescription medications are available with indications for specific types of constipation, and follow-up is important to ensure treatment is appropriate and adequate 3
- Bisacodyl, a stimulant laxative, has been shown to be effective in treating constipation, with similar efficacy to other laxatives such as prucalopride, lubiprostone, and linaclotide 4
Pharmacological Interventions
- Polyethylene glycol (PEG) is a commonly used osmotic laxative for treating constipation, and can be used in combination with other agents such as ascorbic acid or bisacodyl 5, 6
- A new regimen of low-volume PEG plus ascorbic acid has been shown to be effective and safe for same-day bowel cleansing in constipated patients 5
- Bisacodyl suppositories based in polyethylene glycol have been shown to be more effective than conventional bisacodyl suppositories in reducing bowel care time in patients with upper motor neuron paralysis 6
Clinical Practice Guidelines
- The American Gastroenterological Association and the American College of Gastroenterology have developed clinical practice guidelines for the pharmacological management of chronic idiopathic constipation, which include recommendations for the use of various agents such as polyethylene glycol, sodium picosulfate, and linaclotide 7
- The guidelines emphasize the importance of shared decision making between clinicians and patients, taking into account patient preferences, medication cost, and availability 7