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Update on the Management of Chronic Constipation

Current Treatment Options in Gastroenterology volume 15, pages 126–134 (2017)Cite this article

Opinion statement

Chronic constipation (CC) is a highly prevalent disorder encountered by health care providers of all specialties. The diagnosis can be confidently made by taking a careful history, evaluating for warning signs and symptoms, performing an examination, including a digital rectal exam, and using the Rome IV criteria. Treatment should begin at the first visit; most patients require few diagnostic tests to make, or confirm, the diagnosis of CC. Assuming that the patient has persistent symptoms of constipation, despite using traditional therapy (fiber, osmotic agents), then patients should be offered one of the newer treatments, rather than repeating prior treatments, which is a common practice. Lubiprostone, a chloride channel activator, has been shown to safely improve symptoms of CC. Its proven track record of success over the last decade is a common reason why many health care providers choose this as a first-line agent. Alternatively, linaclotide, which stimulates guanylate cyclase C receptors, and which has also been shown to improve symptoms of CC in large, randomized trials, is another logical choice. The decision of which agent to use first often depends upon the patient’s co-payment or insurance plan. Either medication should be given a trial of at least 4–6 weeks. If a patient does not respond, then the patient should be treated with the other agent. If symptoms persist, the clinician should consider the possibility of overlapping, or predominant, pelvic floor dysfunction (PFD). The combination of high-resolution anorectal manometry and a balloon expulsion test can be used to make the diagnosis of PFD. If present, patients should be referred to a knowledgeable physical therapist for pelvic floor retraining. New treatment options are available to treat the multiple symptoms of CC. Co-existing pelvic floor dysfunction should be considered in those patients who fail medical therapy.

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Authors and Affiliations

  1. Department of Medicine, Division of Gastroenterology & Hepatology, Dartmouth Hitchcock Medical Center, 1 Medical Center Dr. 4C, Lebanon, NH, 03766, USA

    Jenna Koliani-Pace MD & Brian E. Lacy PhD, MD

Authors
  1. Jenna Koliani-Pace MD
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  2. Brian E. Lacy PhD, MD
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Correspondence to Jenna Koliani-Pace MD.

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Jenna Koliani-Pace declares that she has no conflict of interest.

Brian E. Lacy is on the scientific advisory boards for Ironwood, Sahx, Prometheus, and Allergan.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Colon

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Koliani-Pace, J., Lacy, B.E. Update on the Management of Chronic Constipation. Curr Treat Options Gastro 15, 126–134 (2017). https://doi.org/10.1007/s11938-017-0118-2

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  • DOI: https://doi.org/10.1007/s11938-017-0118-2

Keywords

  • Chronic constipation
  • Linaclotide
  • Plecanatide
  • Tenapanor
  • Pelvic floor therapy