Skip to main content
SpringerLink
Log in

Treating Chronic Constipation

How Should We Interpret the Recommendations?

  • Review Article
  • Published:
Clinical Drug Investigation Aims and scope Submit manuscript

Abstract

Chronic constipation is a multisymptom gastrointestinal motility disorder that negatively impacts the lives of those affected. New recommendations on diagnosing and treating this condition have recently been published. This review aims to assist clinicians in applying these recommendations in clinical practice. Although lifestyle interventions and bulking agents help some patients with constipation, data are lacking to support their efficacy in those with chronic constipation. If empirical treatment of patients with chronic constipation fails, osmotic laxatives (e.g. lactulose and polyethylene glycol), a serotonin (5-HT4) receptor agonist (e.g. tegaserod) or a chloride channel activator (e.g. lubiprostone) can be considered. Osmotic laxatives, though effective at increasing stool frequency, are often associated with adverse effects such as bloating and diarrhoea and typically do not effectively relieve the multiple symptoms of chronic constipation. Use of tegaserod and the recently approved lubiprostone is supported by high-quality evidence, and these agents have acceptable safety profiles in patients with chronic constipation.

Recent advances in the definition of chronic constipation and in its pharmacological management have led to refinements in identifying the appropriate treatment needs of patients with this condition. It is hoped that these advancements will help clinicians select effective medical regimens for patients with chronic constipation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Table I
Table II
Fig. 1
Table III
Table IV
Table V

Similar content being viewed by others

References

  1. Dennison C, Prasad M, Lloyd A, et al. The health-related quality of life and economic burden of constipation. Pharmacoeconomics 2005; 23(5): 461–76

    Article  PubMed  Google Scholar 

  2. Glia A, Lindberg G. Quality of life in patients with different types of functional constipation. Scand J Gastroenterol 1997 Nov; 32(11): 1083–9

    Article  PubMed  CAS  Google Scholar 

  3. American College of Gastroenterology Chronic Constipation Task Force. An evidence-based approach to the management of chronic constipation in North America. Am J Gastroenterol 2005; 100: S1–4

    Article  Google Scholar 

  4. Brandt LJ, Prather CM, Quigley EMM, et al. Systematic review on the management of chronic constipation in North America. Am J Gastroenterol 2005 Jul; 100: S5–22

    Article  PubMed  Google Scholar 

  5. Locke III GR, Pemberton JH, Phillips SF. American Gastroenterological Association Medical Position Statement: guidelines on constipation. Gastroenterology 2000 Dec; 119(6): 1761–6

    Article  PubMed  Google Scholar 

  6. Locke III GR, Pemberton JH, Phillips SF. AGA technical review on constipation. Gastroenterology 2000 Dec; 119(6): 1766–78

    Article  PubMed  Google Scholar 

  7. WGO-OMGE Practice Guideline: Constipation. World Organisation of Gastroenterology [online]. Available from URL: http://www.omge.org/globalguidelines/guide04/guide-Iine4.htm [Accessed 2006 Jul 27]

  8. National Guideline Clearinghouse [online]. Available from http://www.guideline.gov [Accessed 2006 Aug 30]

  9. Muller-Lissner SA, Kamm MA, Scarpignato C, et al. Myths and misconceptions about chronic constipation. Am J Gastroenterol 2005 Jan; 100(1): 232–42

    Article  PubMed  Google Scholar 

  10. Talley NJ. Definitions, epidemiology, and impact of chronic constipation. Rev Gastroenterol Disord 2004; 4Suppl. 2: S3–10

    PubMed  Google Scholar 

  11. Pare P, Ferrazzi S, Thompson WG, et al. An epidemiological survey of constipation in Canada: definitions, rates, demographics, and predictors of health care seeking. Am J Gastroenterol 2001; 96(11): 3130–7

    Article  PubMed  CAS  Google Scholar 

  12. Herz MJ, Kahan E, Zalevski S, et al. Constipation: a different entity for patients and doctors. Fam Pract 1996 Apr; 13(2): 156–9

    Article  PubMed  CAS  Google Scholar 

  13. Heaton KW, Radvan J, Cripps H, et al. Defecation frequency and timing, and stool form in the general population: a prospective study. Gut 1992 Jun; 33(6): 818–24

    Article  PubMed  CAS  Google Scholar 

  14. Sandler RS, Drossman DA. Bowel habits in young adults not seeking health care. Dig Dis Sci 1987 Aug; 32(8): 841–5

    Article  PubMed  CAS  Google Scholar 

  15. Thompson WG. Functional bowel disorders and functional abdominal pain. In: Drossman DA, Richter JE, Talley NJ, editors. The functional gastrointestinal disorders: diagnosis, pathophysiology, and treatment. McLean (VA): Degnon Associates, 1994: 115–73

    Google Scholar 

  16. Thompson WG, Longstreth GF, Drossman DA, et al. Functional bowel disorders and functional abdominal pain. Gut 1999 Sep; 45: II43–7

    Article  PubMed  Google Scholar 

  17. Longstreth GF, Thompson WG, Chey WD, et al. Functional bowel disorders. Gastroenterology 2006 May; 130: 1480–91

    Article  PubMed  Google Scholar 

  18. Dorland’s medical dictionary. 30th ed. Philadelphia (PA): WB Saunders Co., 2003

  19. Higgins PD, Johanson JF. Epidemiology of constipation in North America: a systematic review. Am J Gastroenterol 2004 Apr; 99(4): 750–9

    Article  PubMed  Google Scholar 

  20. Chinese Society of Gastroenterology, Chinese Medical Association. Consensus on the guidelines for the diagnosis and treatment of chronic constipation. Chin J Dig Dis 2004; 5(3): 134–7

    Article  Google Scholar 

  21. Arce DA, Ermocilla CA, Costa H. Evaluation of constipation. Am Fam Physician 2002 Jun 1; 65(11): 2283–90

    PubMed  Google Scholar 

  22. Borum ML. Constipation: evaluation and management. Prim Care 2001; 28(3): 577–90

    Article  PubMed  CAS  Google Scholar 

  23. Lembo A, Camilleri M. Chronic constipation. N Engl J Med 2003 Oct 2; 349(14): 1360–8

    Article  PubMed  CAS  Google Scholar 

  24. Rao SS. Constipation: evaluation and treatment. Gastroenterol Clin North Am 2003 Jun; 32(2): 659–83

    Article  PubMed  Google Scholar 

  25. Mertz H, Naliboff B, Mayer E. Physiology of refractory chronic constipation. Am J Gastroenterol 1999; 94(3): 609–15

    Article  PubMed  CAS  Google Scholar 

  26. Bassotti G, Chistolini F, Sietchiping-Nzepa F, et al. Biofeedback for pelvic floor dysfunction in constipation. BMJ 2004 Feb 14; 328(7436): 393–6

    Article  PubMed  CAS  Google Scholar 

  27. Enck P. Biofeedback training in disordered defecation: a critical review. Dig Dis Sci 1993 Nov; 38(11): 1953–60

    Article  PubMed  CAS  Google Scholar 

  28. Rao SS, Enck P, Loening-Baucke V. Biofeedback therapy for defecation disorders. Dig Dis 1997; 15Suppl. 1: 78–92

    Article  PubMed  Google Scholar 

  29. Heymen S, Jones KR, Scarlett Y, et al. Biofeedback treatment of constipation: a critical review. Dis Colon Rectum 2003 Sep; 46(9): 1208–17

    Article  PubMed  Google Scholar 

  30. Annells M, Koch T. Constipation and the preached trio: diet, fluid intake, exercise. Int J Nurs Stud 2003 Nov; 40(8): 843–52

    Article  PubMed  Google Scholar 

  31. Evans JM, Fleming KC, Talley NJ, et al. Relation of colonie transit to functional bowel disease in older people: a population-based study. J Am Geriatr Soc 1998; 46(1): 83–7

    PubMed  CAS  Google Scholar 

  32. Meshkinpour H, Selod S, Movahedi H, et al. Effects of regular exercise in management of chronic idiopathic constipation. Dig Dis Sci 1998 Nov; 43(11): 2379–83

    Article  PubMed  CAS  Google Scholar 

  33. Fritz E, Hammer HF, Lipp RW, et al. Effects of lactulose and polyethylene glycol on colonie transit. Aliment Pharmacol Ther 2005 Feb 1; 21(3): 259–68

    Article  PubMed  CAS  Google Scholar 

  34. MiraLax (polyethylene glycol 3550) [prescribing information]. Braintree (MA): Braintree Laboratories Inc., 2003

  35. Pampati V, Fogel R. Treatment options for primary constipation. Curr Treat Options Gastroenterol 2004 Jun; 7(3): 225–33

    Article  PubMed  Google Scholar 

  36. Jones MP, Talley NJ, Nuyts G, et al. Lack of objective evidence of efficacy of laxatives in chronic constipation. Dig Dis Sci 2002 Oct; 47(10): 2222–30

    Article  PubMed  Google Scholar 

  37. Ramkumar D, Rao SSC. Efficacy and safety of traditional medical therapies for chronic constipation: systematic review. Am J Gastroenterol 2005 Apr; 100(4): 936–71

    Article  PubMed  Google Scholar 

  38. Johanson JF, Wald A, Tougas G, et al. Effect of tegaserod in chronic constipation: a randomized, double-blind, controlled trial. Clin Gastroenterol Hepatol 2004 Sep; 2(9): 796–805

    Article  PubMed  CAS  Google Scholar 

  39. Kamm MA, Muller-Lissner S, Talley NJ, et al. Tegaserod for the treatment of chronic constipation: a randomized, doubleblind, placebo-controlled multinational study. Am J Gastroenterol 2005 Feb; 100(2): 362–72

    Article  PubMed  CAS  Google Scholar 

  40. Amitiza (lubiprostone) soft gelatin capsules [prescribing information]. Bethesda (MD): Sucampo Pharmaceuticals Inc., 2006

  41. Johanson JF, Gargano MA, Holland PC, et al. Phase III efficacy and safety of RU-0211, a novel chloride channel activator, for the treatment of constipation [abstract]. Gastroenterology 2003; 124: A104

    Article  Google Scholar 

  42. Johanson JF, Gargano MA, Holland PC, et al. Phase III study of lubiprostone, a chloride channel-2 (CIC-2) activator for the treatment of constipation: safety and primary efficacy [abstract]. Am J Gastroenterol 2005; 100(9): S328–9

    Google Scholar 

  43. Zelnorm® (tegaserod maleate) tablets [prescribing information]. East Hanover (NJ): Novartis Pharmaceuticals Corporation, 2004

  44. Schiller LR. New and emerging treatment options for chronic constipation. Rev Gastroenterol Disord 2004; 4: S43–51

    PubMed  Google Scholar 

  45. Medoff J, Katz S, Malik P, et al. Open-label, dose-ranging pilot study of 4 weeks of low-dose therapy with sodium phosphate tablets in chronically constipated adults. Clin Ther 2004; 26(9): 1479–91

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgements

Dr Johnson is a consultant for Novartis Pharmaceuticals and received clinical investigator research grant support for this study. The author thanks Maribeth Bogush, PhD, and Sophia Shumyatsky, PharmD, for their editorial assistance in the preparation of this manuscript.

Author information

Authors and Affiliations

  1. Department of Gastroenterology, Eastern VA Medical School, Norfolk, Virginia, 23502, USA

    David A. Johnson

Authors
  1. David A. Johnson
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to David A. Johnson.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Johnson, D.A. Treating Chronic Constipation. Clin. Drug Investig. 26, 547–557 (2006). https://doi.org/10.2165/00044011-200626100-00001

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00044011-200626100-00001

Keywords

Search

Navigation