Secondary constipation is a condition that can be caused by a variety of underlying medical issues. While dietary and exercise changes won't treat the root cause, they can help prevent constipation from worsening while doctors treat the underlying cause. In this article, we'll provide an overview of the pathophysiology, diagnosis, current treatments, and available guidelines for treating chronic constipation. We'll also discuss the efficacy and potential clinical use of the most recently available therapeutic agents. Based on published algorithms and guidelines for treating chronic constipation, secondary pathologies and causes are first excluded.
Then, diet, lifestyle, and behavioral measures are adopted. If these don't work, mass-forming laxatives, osmotics, and stimulants can be used. If symptoms don't improve satisfactorily, a prokinetic agent such as prucalopride may be prescribed. Biofeedback is also recommended as a treatment for chronic constipation in patients with defecation disorders.
Surgery should only be considered once all other treatment options have been exhausted. When no secondary cause of constipation is identified, empirical treatment for functional constipation should be tried first. Treatment should begin with non-pharmacological methods to improve bowel regularity and should continue with the use of laxatives if non-pharmacological methods are unsuccessful. If the constipation is resistant to medical treatment, the patient should be referred to a specialist for further diagnostic evaluation. This may include measuring colonic transit time, anorectal manometry, defecography, or a balloon ejection test to assess colonic transit and anorectal function.
Rarely, biofeedback therapy or surgery may be warranted. Patients who are chronically dependent on increasing doses of self-prescribed laxatives are particularly difficult to treat. Most of these patients can be treated with a combination of fiber, water, and osmotic agents (e.g., polyethylene glycol or sorbitol). However, the need to increase the doses of laxatives and the intermittent use of other agents can become problematic. In a recent study of 16 women with chronic constipation who were receiving colchicine, the number of bowel movements improved significantly and the initial side effect of abdominal pain decreased with continued treatment. Larger trials are needed to confirm the efficacy and safety of long-term use of colchicine for treating chronic constipation. Three mu-opioid opioid antagonists (naloxone, methylnaltrexone, and alvimopan) are currently being evaluated for treating opioid-induced constipation (84.85) and postoperative ileus.
Several groups have provided recommendations for diagnosing and treating constipation; however, no standardized treatment guidelines have gained acceptance in general medical practice. Patients with normal functioning constipation benefit most from treatment with laxatives in bulk. It is also largely unknown if laxative treatments address the deterioration in quality of life observed in patients with chronic constipation since most studies have failed to evaluate quality of life measures. As mentioned above, the guidelines and algorithms for managing and treating chronic constipation have not taken into account the most recent therapeutic advances. In an online survey of approximately 4600 American respondents who reported having one or more symptoms of constipation, only one in four reported seeing a doctor in the previous year. A variety of over-the-counter and prescription laxatives are available for treating constipation. However, it's important to note that these treatments should only be used after consulting with a doctor or healthcare professional. In conclusion, there are few detailed guidelines and recommendations available for treating chronic constipation that include the most recently available treatments.
Patients who are chronically dependent on increasing doses of self-prescribed laxatives are perhaps the most difficult patients to treat. If symptoms don't improve satisfactorily after trying non-pharmacological methods or using laxatives in bulk, patients should be referred to a specialist for further diagnostic evaluation.
