Recommendations on Chronic Constipation (including Constipation Associated with Irritable Bowel Syndrome) Treatment

Abstract

While chronic constipation (CC) has a high prevalence in primary care, there are no existing treatment recommendations to guide health care professionals. To address this, a consensus group of 10 gastroenterologists was formed to develop treatment recommendations. Although constipation may occur as a result of organic disease, the present paper addresses only the management of primary CC or constipation associated with irritable bowel syndrome. The final consensus group was assembled and the recommendations were created following the exact process outlined by the Canadian Association of Gastroenterology for the following areas: epidemiology, quality of life and threshold for treatment; definitions and diagnostic criteria; lifestyle changes; bulking agents and stool softeners; osmotic agents; prokinetics; stimulant laxatives; suppositories; enemas; other drugs; biofeedback and behavioural approaches; surgery; and probiotics. A treatment algorithm was developed by the group for CC and constipation associated with irritable bowel syndrome. Where possible, an evidence-based approach and expert opinions were used to develop the statements in areas with insufficient evidence. The nature of the underlying pathophysiology for constipation is often unclear, and it can be tricky for physicians to decide on an appropriate treatment strategy for the individual patient. The myriad of treatment options available to Canadian physicians can be confusing; thus, the main aim of the recommendations and treatment algorithm is to optimize the approach in clinical care based on available evidence.

The efficacy of education programme for preventing constipation in women

“…7,29 Fibre increases stool weight and shortens gut transit time, and increases absorption of water by the stool. 26,30 In this study, increasing pulpy-fibrous nutrient consumption was thought to be beneficial for women in overcoming constipation. Increased dietary fibre intake can result in decreased colonic transit times and increased stool bulk, and should be used as a first-line treatment.…”

Quality of life in children and adults with constipation

“…Such information might influence choice of treatments for functional GI disorders such as chronic constipation. A recent consensus document stated "the threshold to treat patients with chronic constipation should be based on the patient's assessment of their symptoms and on the impact of these symptoms on quality of life" [42].…”

Chronic constipation: diagnosis and current treatment options

“…6 Typically, patients with constipation-predominant irritable bowel syndrome (IBS-C) have NT constipation, although there may be up to a 50 per cent overlap between IBS-C and ST constipation. 7 Normal-transit constipation By definition, colonic motility in NT constipation is unaffected; there is no evidence of outlet obstruction and patients have a normal stool frequency. Consequently, constipation is likely to be due to a perceived difficulty with evacuation or the presence of hard stools.…”