Chronic Constipation: Current Treatment Options

Abstract

Constipation is a common functional gastrointestinal disorder that affects patients of all ages. In 2007, a consensus group of 10 Canadian gastroenterologists developed a set of recommendations pertaining to the management of chronic constipation and constipation dominant irritable bowel syndrome. Since then, tegaserod has been withdrawn from the Canadian market. A new, highly selective serotonin receptor subtype 4 agonist, prucalopride, has been examined in several large, randomized, placebo-controlled trials demonstrating its efficacy and safety in the management of patients with chronic constipation. Additional studies evaluating the use of stimulant laxatives, polyethylene glycol and probiotics in the management of chronic constipation have also been published. The present review summarizes the previous recommendations and new evidence supporting different treatment modalities - namely, diet and lifestyle, bulking agents, stool softeners, osmotic and stimulant laxatives, prucalopride and probiotics in the management of chronic constipation. A brief summary of lubiprostone and linaclotide is also presented. The quality of evidence is presented by adopting the Grading of Recommendations, Assessment, Development and Evaluation system. Finally, a management pyramid for patients with chronic constipation is proposed based on the quality of evidence, impact of each modality on constipation and on general health, and their availabilities in Canada.

Effects of Fructo-Oligosaccharide Supplementation on Constipation in Elderly Continuous Ambulatory Peritoneal Dialysis Patients

“…Moreover, constipation in the PD population is believed to be a risk factor for developing peritonitis as a result of transmural migration of bacteria and rare colonic perforation (3)(4)(5). A widely accepted recommendation for the initial treatment of constipation includes high dietary fiber intake and bulk-forming agents such as psyllium (6). In subjects unresponsive to fiber, both osmotic and stimulant laxatives are effective.…”

“…In subjects unresponsive to fiber, both osmotic and stimulant laxatives are effective. However, the latter tends to be recommended for occasional use as the long-term safety profile is unclear (6,7).…”

Prokinetic and laxative effects of Xiao'er Qixingcha, a household pediatric herbal formula

“…However, the existing treatments for constipation are still far from satisfactory due to various adverse effects (Liu, 2011, Wald, 2007. Currently, active researches have rekindled interest in natural drugs, such as Liriope platyphylla (Kim et al, 2013) and agarwood (Hara et al, 2008), and there has been an increased inclination towards herbal formulations like Ma Zi Ren Wan (Zhong et al, 2013).…”

“…It not only causes physical and mental suffering for patients but also has adverse effects on their quality of life by increasing the risk of anxiety, abdominal distension, vomiting, gut obstruction and perforation (Mostafa et al, 2003). To date, a lot of drugs, including bulking agents, stool softeners, osmotic laxatives and stimulant laxatives, have been used cautiously for treating constipation (Liu, 2011, Wald, 2007. However, their adverse effects, such as nausea, vomit, abdominal pain, dependency and cathartic colon, have raised public concern (Liu, 2011, Wald, 2007.…”

“…To date, a lot of drugs, including bulking agents, stool softeners, osmotic laxatives and stimulant laxatives, have been used cautiously for treating constipation (Liu, 2011, Wald, 2007. However, their adverse effects, such as nausea, vomit, abdominal pain, dependency and cathartic colon, have raised public concern (Liu, 2011, Wald, 2007. Hence, the search for safe and effective laxative never stops in consideration of various harmful adverse effects and the prevalence of constipation.…”