Materiały źródłowe

• #1 Constipation – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/constipation/diagnosis-treatment/drc-20354259

  Treatment for constipation usually begins with diet and lifestyle changes meant to increase the speed at which stool moves through the colon. Also, your health care professional may change the medicines you take if they may be causing or worsening constipation. If those changes don’t help, other treatments may be necessary. […] Your doctor may recommend the following changes to relieve your constipation: […] Prunes, also called dried plums, have long been used to treat or prevent constipation. Prunes are a good source of fiber, but they also have naturally present agents that draw fluids into the colon. […] Laxatives are medicines that help move stool through the colon. Each laxative works somewhat differently. The following are available without prescriptions: […] An enema is a fluid gently pumped into the rectum to help pass stool. An enema may be used when other treatments don’t work.

• #2 Treatment for Constipation – NIDDK

  https://www.niddk.nih.gov/health-information/digestive-diseases/constipation/treatment

  You can most often treat your constipation at home by doing the following […] Changing what you eat and drink may make your stools softer and easier to pass. To help relieve your symptoms […] You may be able to treat and prevent your constipation by changing what you eat and drink. […] Getting regular physical activity may help relieve your symptoms. […] Your doctor may suggest that you try to train yourself to have a bowel movement at the same time each day to help you become more regular. […] If you think certain medicines or dietary supplements are causing your constipation, talk with your doctor. […] Your health care professional may recommend using a laxative for a short time. […] You should only use stimulants if your constipation is severe or other treatments have not worked.

• #3 Constipation Treatment & Management: Approach Considerations, Dietary Measures, Pharmacologic Therapy

  https://emedicine.medscape.com/article/184704-treatment

  Manual disimpaction and transrectal enemas may be used after any critical illness associated with constipation has been ruled out. […] Medical care should focus on dietary change and exercise rather than laxatives, enemas, and suppositories, none of which really address the underlying problem. […] The key to treating most patients with constipation is correction of dietary deficiencies. […] Surgical care is generally restricted to the evaluation of underlying causes or the management of acute complications of constipation. […] Once acute constipation has resolved and the associated medical or surgical conditions have been ruled out, additional inpatient care is rarely indicated. […] An international expert consensus (Delphi Survey) established five symptoms and their severities to define treatment failure to provide adequate relief in patients with chronic constipation.

• #4 Constipation – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK513291/

  The treatment of adults with constipation involves a comprehensive approach that addresses the underlying causes and focuses on promoting regular bowel movements and symptom relief. Initially, dietary and lifestyle modifications play a crucial role, emphasizing increased fiber intake from fruits, vegetables, whole grains, and adequate hydration to soften stools. […] For patients with pelvic floor dysfunction, physical therapy focusing on the pelvic floor can be helpful. Biofeedback therapy, or cognitive-behavioral therapy, can be beneficial, particularly when stress or anxiety exacerbates symptoms. Over-the-counter medications such as bulk-forming agents, stool softeners, or osmotic agents may provide short-term relief, but their extended use should be monitored. […] When these measures prove insufficient, prescription medications may be considered. Multiple options exist. A bicyclic fatty acid derived from prostaglandin E1, lubiprostone, a chloride channel activator, increases intestinal fluid and accelerates GI transit. […] Linaclotide, a guanylate cyclase-C agonist, is also FDA-approved for treating chronic idiopathic constipation at 72 g or 145 g daily doses. […] Another prescription alternative approved for chronic idiopathic constipation is plecanatide, a pH-dependent guanylate cyclase-C agonist. […] An additional option, prucalopride, a selective agonist of serotonin 5-HT4 receptors, induces and increases the amplitude of colonic high-amplitude propagated contractions, thereby increasing bowel movement frequency and relieving constipation symptoms.

• #5 Constipation | Causes, Symptoms, Treatment & Support | Guts UK

  https://gutscharity.org.uk/advice-and-information/symptoms/constipation/

  This factsheet helps to explain the symptoms of constipation and what causes them. It will help you to identify when it is a problem needing your doctor to investigate it. The information also highlights what treatments are available to help reduce symptoms. […] Constipation is a problem for some people who need to take medicines. […] Treatment is generally orientated around lifestyle changes: […] Dietary changes. Regular meals and a good fluid intake are the main lifestyle changes in preventing and treating constipation. […] A high fibre diet. This may help some patients with constipation. […] Aim to include a high fibre food at each meal along with at least five portions of fruit or vegetables each day. […] If you have IBS the advice may be different, the British Dietetic Association has a fact sheet.

• #6 Constipation | NHS inform

  https://www.nhsinform.scot/illnesses-and-conditions/stomach-liver-and-gastrointestinal-tract/constipation/

  There are a number of things you can do to prevent constipation, including making diet and lifestyle changes. […] Including enough fibre in your diet can significantly reduce your chances of developing constipation. […] You should aim to have about 30g of fibre a day. […] Make sure you drink plenty of fluids to avoid dehydration, and steadily increase your intake when exercising or when it’s hot. […] Keeping active and mobile will greatly reduce your risk of getting constipation.

• #7 Constipation: Symptoms & Causes

  https://my.clevelandclinic.org/health/diseases/4059-constipation

  Constipation happens because your colon (large intestine) absorbs too much water from your poop. This dries out your poop, making it hard in consistency and difficult to push out of your body. […] You can manage most cases of mild to moderate constipation at home. Self-care starts by taking an inventory of what you eat and drink and then making changes. […] Some recommendations for immediate constipation relief at home include: Drink two to four extra glasses of water a day. Avoid caffeine-containing drinks and alcohol, which can cause dehydration. Also, avoid juice and high-sweetened beverages. […] In addition to self-care methods, your healthcare provider will review your medications and supplements (if you take any). Some of these products can cause constipation. If they do, your provider may change the dose, switch to another drug and/or ask that you stop taking the supplement.

• #8 Constipation Relief: How To Get Rid of Constipation

  https://www.webmd.com/digestive-disorders/constipation-relief-tips

  There are a few effective constipation treatments. […] But if you do, there are a lot of options for constipation treatment. What you choose will depend on why you’re blocked, and whether it’s a new or a long-term problem for you. […] You may be able to solve your constipation problem yourself, without your doctor’s help. […] Fiber makes stool bulkier and softer, making it easier to pass. […] Water is important for preventing constipation, too. […] While caffeinated drinks and alcohol can make you dehydrated, there’s evidence a cup of coffee or tea in the morning may be an effective constipation treatment. […] Other things you can do to relieve constipation include: Regular exercise, Adjust your toilet posture, Check your meds, Biofeedback, Massage, Enemas, Prebiotics and probiotics, Bowel training.

• #9 Constipation | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/constipation

  Most cases of constipation are successfully treated by eating a diet high in fibre, drinking more fluids and exercising daily. […] Over-the-counter laxatives are fine in the short term, but seek advice if the problem persists. […] Treatment depends on the cause, but could include: Stopping or changing medications that can cause constipation. […] Removal of the impacted faeces which may involve enemas, stool softeners and a short-term course of laxatives. […] Dietary changes such as increasing the amount of fibre in the daily diet. […] More fluids liquids help to plump out faeces. […] Fibre supplements these may be helpful if the person is reluctant or unable to include more wholegrain foods, fresh fruits or vegetables in their daily diet. […] Exercise one of the many benefits of regular exercise is improved bowel motility.

• #10 How To Prevent and Treat Chronic Constipation | Northwestern Medicine

  https://www.nm.org/healthbeat/healthy-tips/how-to-prevent-and-treat-constipation

  When you body doesnt follow its natural rhythm, it can lead to constipation the most common gastrointestinal issue. […] Constipation can be categorized into three types, each with different causes. […] You dont have to turn to medication right away to relieve constipation. There are many other simple interventions that you can try first. […] A high-fiber diet is essential. Aim for 25 to 30 grams of fiber daily from food or supplements, which you can get at your pharmacy. […] Regular movement can promote bowel health. Walking is an effective way to encourage bowel movements. […] Chronic constipation related to pelvic floor issues may benefit from pelvic floor therapy, including biofeedback.

• #11 Treatment for Constipation – NIDDK

  https://www.niddk.nih.gov/health-information/digestive-diseases/constipation/treatment

  You can most often treat your constipation at home by doing the following […] Changing what you eat and drink may make your stools softer and easier to pass. To help relieve your symptoms […] You may be able to treat and prevent your constipation by changing what you eat and drink. […] Getting regular physical activity may help relieve your symptoms. […] Your doctor may suggest that you try to train yourself to have a bowel movement at the same time each day to help you become more regular. […] If you think certain medicines or dietary supplements are causing your constipation, talk with your doctor. […] Your health care professional may recommend using a laxative for a short time. […] You should only use stimulants if your constipation is severe or other treatments have not worked.

• #12 Constipation Relief: How To Get Rid of Constipation

  https://www.webmd.com/digestive-disorders/constipation-relief-tips

  There are a few effective constipation treatments. […] But if you do, there are a lot of options for constipation treatment. What you choose will depend on why you’re blocked, and whether it’s a new or a long-term problem for you. […] You may be able to solve your constipation problem yourself, without your doctor’s help. […] Fiber makes stool bulkier and softer, making it easier to pass. […] Water is important for preventing constipation, too. […] While caffeinated drinks and alcohol can make you dehydrated, there’s evidence a cup of coffee or tea in the morning may be an effective constipation treatment. […] Other things you can do to relieve constipation include: Regular exercise, Adjust your toilet posture, Check your meds, Biofeedback, Massage, Enemas, Prebiotics and probiotics, Bowel training.

• #13 Constipation Treatment & Management: Approach Considerations, Dietary Measures, Pharmacologic Therapy

  https://emedicine.medscape.com/article/184704-treatment

  The key to treating most patients with constipation is correction of dietary deficiencies. This generally involves increasing intake of fiber and fluid and decreasing the use of constipating agents, such as milk products, coffee, tea, and alcohol. […] Medications to treat constipation include bulk-forming agents (fibers), emollient stool softeners, rapidly acting lubricants, prokinetics, laxatives, osmotic agents, and prosecretory drugs. […] Use sodium phosphate products with precaution, particularly in young children; patients older than 55 years; patients who are dehydrated; patients with kidney disease, bowel obstruction, or inflammation of the bowel; and patients who are using medications that may affect kidney function. […] Fiber is arguably the best and least expensive medication for long-term treatment, although enthusiasm for the use of polyethylene glycol as first-line therapy in chronic constipation is increasing.

• #14 Chronic Constipation in Adults | AAFP

  https://www.aafp.org/pubs/afp/issues/2022/0900/chronic-constipation-adults.html

  Chronic constipation is classified as primary (normal transit, slow transit, defecatory disorders, or a combination) or secondary (due to medications, chronic diseases, or anatomic abnormalities). […] First-line treatment for primary constipation includes ensuring adequate fluid intake, dietary fiber supplementation, and osmotic laxatives. […] Second-line therapy includes a brief trial of stimulant laxatives followed by intestinal secretagogues. […] Patients with refractory constipation may be considered for surgery. […] Those in whom pelvic floor dysfunction is identified early should be referred for pelvic floor therapy with biofeedback while first-line medications, such as bulk or osmotic laxatives, are initiated. […] Pelvic floor therapy with biofeedback is superior to laxatives, sham therapy, and placebo in RCTs for defecatory dysfunction.

• #15 Medicine to Treat Constipation

  https://www.webmd.com/digestive-disorders/prescription-medications-to-treat-constipation

  There are a lot of medicines to choose from for relief from chronic constipation. Some are over-the-counter treatments, and others need a doctor’s prescription. […] Your doctor can also check to see if any medicines you take to treat other conditions might be part of the problem. […] Many people start with products they can buy without a prescription. Your doctor can help you choose the right product for you. […] Some types of OTC products that you can take are: Fiber supplements. They absorb water to help form bulky stool to get your bowels going. […] Osmotics. These help draw water into your large intestine, so your stool is softer. […] Stimulants. Its better to try these if your constipation is severe and other drugs haven’t worked. […] Stool softeners. You might get these if you need to avoid straining when you have a movement, like after surgery.

• #16 Constipation Treatment & Management: Approach Considerations, Dietary Measures, Pharmacologic Therapy

  https://emedicine.medscape.com/article/184704-treatment

  The key to treating most patients with constipation is correction of dietary deficiencies. This generally involves increasing intake of fiber and fluid and decreasing the use of constipating agents, such as milk products, coffee, tea, and alcohol. […] Medications to treat constipation include bulk-forming agents (fibers), emollient stool softeners, rapidly acting lubricants, prokinetics, laxatives, osmotic agents, and prosecretory drugs. […] Use sodium phosphate products with precaution, particularly in young children; patients older than 55 years; patients who are dehydrated; patients with kidney disease, bowel obstruction, or inflammation of the bowel; and patients who are using medications that may affect kidney function. […] Fiber is arguably the best and least expensive medication for long-term treatment, although enthusiasm for the use of polyethylene glycol as first-line therapy in chronic constipation is increasing.

• #17 Management of Constipation in Older Adults | AAFP

  https://www.aafp.org/pubs/afp/issues/2015/0915/p500.html

  Most older adults with chronic constipation eventually require a laxative to alleviate symptoms. A systematic review of laxative treatment in older persons showed varying degrees of effectiveness and concluded that therapy should be individualized. […] Enemas and suppositories can be useful for fecal impaction or in patients who cannot tolerate oral preparations. Phosphate enemas should be avoided in older adults because of the high risk of electrolyte disturbances, which are sometimes fatal. Mineral oil enemas are a safer alternative to phosphate enemas, with local adverse effects of perianal irritation or soreness. […] Bulking agents may be soluble, such as psyllium (Metamucil), or insoluble, such as bran, methylcellulose (Citrucel), and polycarbophil (Fibercon). These agents absorb water into the intestine to soften the stool and increase bulk.

• #18 Constipation & Defecation Problems | ACG

  https://gi.org/topics/constipation-and-defection-problems/

  After the hard stool has been removed, the patient is told to add fiber to the diet or to use laxatives to prevent constipation. Laxatives may be used every two to three days or even regularly. […] If the stool is not impacted, there are several ways of treating constipation. Increasing the intake of water and fiber is often the first step. Vegetables, fruit (especially prunes), whole-grain breads, and high-fiber cereals are excellent sources of fiber. Bran is an alternative source, although it may cause excessive gas and bloating. To prevent gas, fiber should be eaten with plenty of fluids. […] Laxatives and stool softeners are sometimes needed if changes in diet are insufficient. Most laxatives are safe for long-term uses, if used appropriately. […] Bulking agents, such as psyllium and methylcellulose, are laxatives that help hold water in the stool and add bulk to it. The increased bulk causes movements of the large intestines, making the stool easy to pass.

• #19 Management of Constipation in Older Adults | AAFP

  https://www.aafp.org/pubs/afp/issues/2015/0915/p500.html

  Osmotic laxatives are not absorbable. These laxatives draw water into the intestinal lumen. Lactulose and sorbitol are hyperosmolar sugar alcohols that increase frequency of defecation and reduce straining. […] Three RCTs involving older patients showed a benefit of docusate sodium (Colace) over placebo in the treatment of constipation. […] Senna and bisacodyl (Dulcolax) promote intestinal motility and increase fluid secretion into the bowel. […] Lubiprostone (Amitiza), a chloride channel activator that moves water into the intestinal lumen, is approved by the U.S. Food and Drug Administration for long-term treatment of chronic constipation in adults. […] Linaclotide (Linzess) increases intestinal fluid secretion and motility. It is approved by the U.S. Food and Drug Administration for chronic constipation and irritable bowel syndrome.

• #20 Chronic Constipation in Adults | AAFP

  https://www.aafp.org/pubs/afp/issues/2022/0900/chronic-constipation-adults.html

  Polyethylene glycol (Miralax) is preferred over lactulose for the treatment of constipation because it is more effective and has fewer adverse effects. […] Linaclotide (Linzess) and lubiprostone (Amitiza) are more effective than placebo for chronic constipation. […] First-line pharmacologic treatment options for normal transit and slow transit constipation include bulk laxatives and osmotic laxatives. […] Second-line therapies include stimulant laxatives, stool softeners, and newer agents. […] Biofeedback therapy is consistently superior to laxatives, sham therapy, and placebo in randomized controlled trials for defecatory dysfunction. […] For patients with opioid-induced constipation, peripherally acting mu-opioid receptor antagonists (PAMORAs), such as naloxegol (Movantik), methylnaltrexone (Relistor), and naldemedine (Symproic), are more effective than placebo in decreasing time to defecation and reducing the need for laxative therapy. […] When second-line therapies, including stimulant laxatives, have failed, patients should be referred to gastroenterology for further diagnostic testing.

• #21 Management of Constipation in Older Adults | AAFP

  https://www.aafp.org/pubs/afp/issues/2015/0915/p500.html

  Osmotic laxatives are not absorbable. These laxatives draw water into the intestinal lumen. Lactulose and sorbitol are hyperosmolar sugar alcohols that increase frequency of defecation and reduce straining. […] Three RCTs involving older patients showed a benefit of docusate sodium (Colace) over placebo in the treatment of constipation. […] Senna and bisacodyl (Dulcolax) promote intestinal motility and increase fluid secretion into the bowel. […] Lubiprostone (Amitiza), a chloride channel activator that moves water into the intestinal lumen, is approved by the U.S. Food and Drug Administration for long-term treatment of chronic constipation in adults. […] Linaclotide (Linzess) increases intestinal fluid secretion and motility. It is approved by the U.S. Food and Drug Administration for chronic constipation and irritable bowel syndrome.

• #22 Constipation Treatment & Management: Approach Considerations, Dietary Measures, Pharmacologic Therapy

  https://emedicine.medscape.com/article/184704-treatment

  Chronic constipation that responds poorly to laxatives may be due to the use of drugs such as opioids or from defecation disorders and advanced colonic dysmotility. […] The FDA approved prucalopride, a serotonin-4 receptor agonist indicated for chronic idiopathic constipation (CIC), in December 2018. […] Lubiprostone and linaclotide are FDA approved for chronic idiopathic constipation and constipation caused by irritable bowel syndrome (IBS). […] Surgical care is generally restricted to the evaluation of underlying causes, such as large bowel obstruction, volvulus, or intra-abdominal infection or ischemia. […] There is increasing interest in the use of sacral nerve stimulation in carefully selected patients with severe refractory constipation. […] First-line treatment is fiber supplementation, increased water intake, gentle exercise, and occasional laxative use as required.

• #23 Management of Constipation in Older Adults | AAFP

  https://www.aafp.org/pubs/afp/issues/2015/0915/p500.html

  Osmotic laxatives are not absorbable. These laxatives draw water into the intestinal lumen. Lactulose and sorbitol are hyperosmolar sugar alcohols that increase frequency of defecation and reduce straining. […] Three RCTs involving older patients showed a benefit of docusate sodium (Colace) over placebo in the treatment of constipation. […] Senna and bisacodyl (Dulcolax) promote intestinal motility and increase fluid secretion into the bowel. […] Lubiprostone (Amitiza), a chloride channel activator that moves water into the intestinal lumen, is approved by the U.S. Food and Drug Administration for long-term treatment of chronic constipation in adults. […] Linaclotide (Linzess) increases intestinal fluid secretion and motility. It is approved by the U.S. Food and Drug Administration for chronic constipation and irritable bowel syndrome.

• #24 Constipation Relief: Quick Home Remedies

  https://www.healthline.com/health/digestive-health/how-to-make-yourself-poop

  Osmotic laxatives work slightly differently than stimulant laxatives. They help move fluids through the colon. […] A stool softener, such as docusate sodium (Colace) or docusate calcium (Surfak), can moisten the stool by pulling water from your intestines. […] Enemas work by softening stool enough to produce a bowel movement. […] Rectal suppositories inserted into the rectum can soften stool and help encourage bowel movements. […] Light exercises like walking or yoga can encourage bowel movements by increasing blood flow throughout your abdomen. […] Manually massaging the colon may help stimulate the bowels for people whose constipation is caused by the slow movement of stool through the colon. […] Natural remedies like probiotics may help treat and prevent constipation. […] If your constipation lasts more than a week and doesn’t respond to treatment, a doctor may be able to rule out serious causes and find an effective treatment. […] Home remedies include increasing your fiber intake or taking a laxative, using a suppository, or taking a stool softener.

• #25 Constipation Relief: How To Get Rid of Constipation

  https://www.webmd.com/digestive-disorders/constipation-relief-tips

  The remedies mentioned above may help trigger your bowels, but may not provide immediate relief. […] To soften your stools and avoid constipation, you should eat enough daily fiber and drink plenty of water or other liquids such as no-sugar-added fruit juice, vegetable juice, or broth, which help the fiber work better in your gut. […] In addition to adding high-fiber foods to avoid constipation, there are other foods and remedies that can act as a natural constipation treatment. […] A box of laxatives shouldn’t be the first place you turn to relieve constipation. […] If your doctor recommends laxatives, ask what type is best for you, and for how long you should take them. […] Laxatives come in several forms: Bulk-forming fiber supplements, Lubricant laxatives, Osmotic laxatives, Stimulant laxatives, Stool softeners.

• #26 Medicine to Treat Constipation

  https://www.webmd.com/digestive-disorders/prescription-medications-to-treat-constipation

  Besides constipation treatments that come in pill form, your doctor may also suggest suppositories or enemas: Suppositories. These go directly into your rectum. […] Enemas. With these, you push fluid directly into your rectum. […] If OTC products don’t help enough, there are a variety of Rx medicines that work in different ways. […] Lactulose. This drug is an osmotic that draws water into the bowel to soften and loosen the stool. […] Linaclotide. This is a capsule you take once a day. It’s used to treat chronic idiopathic constipation (CIC) and irritable bowel syndrome with constipation (IBS-C). […] Lubiprostone. Your doctor may suggest this drug if you have chronic constipation or constipation brought on by opioids. […] Plecanatide. It’s a tablet you take once a day. It helps your body make fluids in your intestines, which helps your stool move through the bowel.

• #27 Constipation Treatment & Management: Approach Considerations, Dietary Measures, Pharmacologic Therapy

  https://emedicine.medscape.com/article/184704-treatment

  Chronic constipation that responds poorly to laxatives may be due to the use of drugs such as opioids or from defecation disorders and advanced colonic dysmotility. […] The FDA approved prucalopride, a serotonin-4 receptor agonist indicated for chronic idiopathic constipation (CIC), in December 2018. […] Lubiprostone and linaclotide are FDA approved for chronic idiopathic constipation and constipation caused by irritable bowel syndrome (IBS). […] Surgical care is generally restricted to the evaluation of underlying causes, such as large bowel obstruction, volvulus, or intra-abdominal infection or ischemia. […] There is increasing interest in the use of sacral nerve stimulation in carefully selected patients with severe refractory constipation. […] First-line treatment is fiber supplementation, increased water intake, gentle exercise, and occasional laxative use as required.

• #28 Management of Constipation in Older Adults | AAFP

  https://www.aafp.org/pubs/afp/issues/2015/0915/p500.html

  Osmotic laxatives are not absorbable. These laxatives draw water into the intestinal lumen. Lactulose and sorbitol are hyperosmolar sugar alcohols that increase frequency of defecation and reduce straining. […] Three RCTs involving older patients showed a benefit of docusate sodium (Colace) over placebo in the treatment of constipation. […] Senna and bisacodyl (Dulcolax) promote intestinal motility and increase fluid secretion into the bowel. […] Lubiprostone (Amitiza), a chloride channel activator that moves water into the intestinal lumen, is approved by the U.S. Food and Drug Administration for long-term treatment of chronic constipation in adults. […] Linaclotide (Linzess) increases intestinal fluid secretion and motility. It is approved by the U.S. Food and Drug Administration for chronic constipation and irritable bowel syndrome.

• #29 Chronic constipation: Update on management | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/84/5/397

  Nonpharmacologic treatments are the first-line options for patients with normal-transit and slow-transit constipation and should precede diagnostic testing. […] Lifestyle modifications and dietary changes aim to augment the known factors that stimulate the gastrocolic reflex and increase intestinal motility by high-amplitude propagated contractions. […] Fiber remains a key part of the initial management of chronic constipation, as it is cheap, available, and safe. […] Osmotic laxatives are often employed as a first-line laxative treatment option for patients with constipation. […] Stimulant laxatives include glycerin, bisacodyl, senna, and sodium picosulfate. […] Stool softeners enhance the interaction of stool and water, leading to softer stool and easier evacuation. […] The secretagogues include lubiprostone, linaclotide, and plecanatide.

• #30 Management of Constipation in Older Adults | AAFP

  https://www.aafp.org/pubs/afp/issues/2015/0915/p500.html

  Osmotic laxatives are not absorbable. These laxatives draw water into the intestinal lumen. Lactulose and sorbitol are hyperosmolar sugar alcohols that increase frequency of defecation and reduce straining. […] Three RCTs involving older patients showed a benefit of docusate sodium (Colace) over placebo in the treatment of constipation. […] Senna and bisacodyl (Dulcolax) promote intestinal motility and increase fluid secretion into the bowel. […] Lubiprostone (Amitiza), a chloride channel activator that moves water into the intestinal lumen, is approved by the U.S. Food and Drug Administration for long-term treatment of chronic constipation in adults. […] Linaclotide (Linzess) increases intestinal fluid secretion and motility. It is approved by the U.S. Food and Drug Administration for chronic constipation and irritable bowel syndrome.

• #31 Chronic Constipation in Adults | AAFP

  https://www.aafp.org/pubs/afp/issues/2022/0900/chronic-constipation-adults.html

  Polyethylene glycol (Miralax) is preferred over lactulose for the treatment of constipation because it is more effective and has fewer adverse effects. […] Linaclotide (Linzess) and lubiprostone (Amitiza) are more effective than placebo for chronic constipation. […] First-line pharmacologic treatment options for normal transit and slow transit constipation include bulk laxatives and osmotic laxatives. […] Second-line therapies include stimulant laxatives, stool softeners, and newer agents. […] Biofeedback therapy is consistently superior to laxatives, sham therapy, and placebo in randomized controlled trials for defecatory dysfunction. […] For patients with opioid-induced constipation, peripherally acting mu-opioid receptor antagonists (PAMORAs), such as naloxegol (Movantik), methylnaltrexone (Relistor), and naldemedine (Symproic), are more effective than placebo in decreasing time to defecation and reducing the need for laxative therapy. […] When second-line therapies, including stimulant laxatives, have failed, patients should be referred to gastroenterology for further diagnostic testing.

• #32 Medicine to Treat Constipation

  https://www.webmd.com/digestive-disorders/prescription-medications-to-treat-constipation

  Besides constipation treatments that come in pill form, your doctor may also suggest suppositories or enemas: Suppositories. These go directly into your rectum. […] Enemas. With these, you push fluid directly into your rectum. […] If OTC products don’t help enough, there are a variety of Rx medicines that work in different ways. […] Lactulose. This drug is an osmotic that draws water into the bowel to soften and loosen the stool. […] Linaclotide. This is a capsule you take once a day. It’s used to treat chronic idiopathic constipation (CIC) and irritable bowel syndrome with constipation (IBS-C). […] Lubiprostone. Your doctor may suggest this drug if you have chronic constipation or constipation brought on by opioids. […] Plecanatide. It’s a tablet you take once a day. It helps your body make fluids in your intestines, which helps your stool move through the bowel.

• #33 Constipation – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK513291/

  The treatment of adults with constipation involves a comprehensive approach that addresses the underlying causes and focuses on promoting regular bowel movements and symptom relief. Initially, dietary and lifestyle modifications play a crucial role, emphasizing increased fiber intake from fruits, vegetables, whole grains, and adequate hydration to soften stools. […] For patients with pelvic floor dysfunction, physical therapy focusing on the pelvic floor can be helpful. Biofeedback therapy, or cognitive-behavioral therapy, can be beneficial, particularly when stress or anxiety exacerbates symptoms. Over-the-counter medications such as bulk-forming agents, stool softeners, or osmotic agents may provide short-term relief, but their extended use should be monitored. […] When these measures prove insufficient, prescription medications may be considered. Multiple options exist. A bicyclic fatty acid derived from prostaglandin E1, lubiprostone, a chloride channel activator, increases intestinal fluid and accelerates GI transit. […] Linaclotide, a guanylate cyclase-C agonist, is also FDA-approved for treating chronic idiopathic constipation at 72 g or 145 g daily doses. […] Another prescription alternative approved for chronic idiopathic constipation is plecanatide, a pH-dependent guanylate cyclase-C agonist. […] An additional option, prucalopride, a selective agonist of serotonin 5-HT4 receptors, induces and increases the amplitude of colonic high-amplitude propagated contractions, thereby increasing bowel movement frequency and relieving constipation symptoms.

• #34 Medicine to Treat Constipation

  https://www.webmd.com/digestive-disorders/prescription-medications-to-treat-constipation

  Polyethylene glycol (PEG). This powder gets mixed with water. When you drink it, it puts a lot of water into your colon to help you go. […] Prucalopride. You take this tablet once a day. It helps your colon make movements to get your stool going through your bowel. […] In addition to the OTC and prescription medicines (along with lifestyle changes), you may also want to know about these methods. […] Biofeedback: This helps you train the muscles that control bowel movements. […] Surgery: It’s rare for people to need this to treat constipation.

• #35 Constipation Treatment & Management: Approach Considerations, Dietary Measures, Pharmacologic Therapy

  https://emedicine.medscape.com/article/184704-treatment

  Chronic constipation that responds poorly to laxatives may be due to the use of drugs such as opioids or from defecation disorders and advanced colonic dysmotility. […] The FDA approved prucalopride, a serotonin-4 receptor agonist indicated for chronic idiopathic constipation (CIC), in December 2018. […] Lubiprostone and linaclotide are FDA approved for chronic idiopathic constipation and constipation caused by irritable bowel syndrome (IBS). […] Surgical care is generally restricted to the evaluation of underlying causes, such as large bowel obstruction, volvulus, or intra-abdominal infection or ischemia. […] There is increasing interest in the use of sacral nerve stimulation in carefully selected patients with severe refractory constipation. […] First-line treatment is fiber supplementation, increased water intake, gentle exercise, and occasional laxative use as required.

• #36 Constipation Treatment & Management: Approach Considerations, Dietary Measures, Pharmacologic Therapy

  https://emedicine.medscape.com/article/184704-treatment

  The first-line therapy remains dietary manipulation, with increased fluid intake and increased ingestion of fiber, whether via natural sources such as fruits and vegetables or via supplements containing more purified forms of fiber. […] Opioid-induced constipation (OIC) is a common adverse effect of opioid use. […] Medications to treat OIC and provide analgesia have been approved by the FDA. […] Methylnaltrexone (Relistor) is a PAMORA indicated for opioid-induced constipation in adults with chronic noncancer pain. […] Naldemedine (Symproic), another PAMORA, was approved by the FDA in March 2017 for opioid-induced constipation in adults with noncancer pain.

• #37 Opioid-induced Constipation: Old and New Concepts in Diagnosis and Treatment

  https://www.jnmjournal.org/journal/view.html?volume=30&number=2&spage=131

  Standard laxatives are a class of drugs that can cause laxation according to different mechanisms of action. […] The use of osmotic laxatives is recommended as a first line of treatment in OIC. […] When the therapeutic response is inadequate or absent, increasing the dose or adding a second laxative with a different mechanism of action (for example, a stimulant laxative) is suggested before moving on to second-line treatment. […] Peripherally acting -opioid receptor antagonists (PAMORAs) selectively block -receptors in the gastrointestinal tract, antagonizing the side effects of opioid drugs. […] The use of naldemedine, naloxegol, and methylenexone is approved by the EMA for treating OIC in patients who have not had a satisfactory clinical response to standard laxatives. […] Opioid therapy has several side effects on digestive functions that can alter bowel habits and defecator patterns. […] In practice, a stepwise approach is highly recommended, starting with lifestyle changes, then osmotic laxatives as first-line therapy, and adding a second laxative if a single one is insufficient.

• #38 Constipation Treatment & Management: Approach Considerations, Dietary Measures, Pharmacologic Therapy

  https://emedicine.medscape.com/article/184704-treatment

  The first-line therapy remains dietary manipulation, with increased fluid intake and increased ingestion of fiber, whether via natural sources such as fruits and vegetables or via supplements containing more purified forms of fiber. […] Opioid-induced constipation (OIC) is a common adverse effect of opioid use. […] Medications to treat OIC and provide analgesia have been approved by the FDA. […] Methylnaltrexone (Relistor) is a PAMORA indicated for opioid-induced constipation in adults with chronic noncancer pain. […] Naldemedine (Symproic), another PAMORA, was approved by the FDA in March 2017 for opioid-induced constipation in adults with noncancer pain.

• #39 Chronic Constipation in Adults | AAFP

  https://www.aafp.org/pubs/afp/issues/2022/0900/chronic-constipation-adults.html

  Polyethylene glycol (Miralax) is preferred over lactulose for the treatment of constipation because it is more effective and has fewer adverse effects. […] Linaclotide (Linzess) and lubiprostone (Amitiza) are more effective than placebo for chronic constipation. […] First-line pharmacologic treatment options for normal transit and slow transit constipation include bulk laxatives and osmotic laxatives. […] Second-line therapies include stimulant laxatives, stool softeners, and newer agents. […] Biofeedback therapy is consistently superior to laxatives, sham therapy, and placebo in randomized controlled trials for defecatory dysfunction. […] For patients with opioid-induced constipation, peripherally acting mu-opioid receptor antagonists (PAMORAs), such as naloxegol (Movantik), methylnaltrexone (Relistor), and naldemedine (Symproic), are more effective than placebo in decreasing time to defecation and reducing the need for laxative therapy. […] When second-line therapies, including stimulant laxatives, have failed, patients should be referred to gastroenterology for further diagnostic testing.

• #40 Constipation Treatment & Management: Approach Considerations, Dietary Measures, Pharmacologic Therapy

  https://emedicine.medscape.com/article/184704-treatment

  The first-line therapy remains dietary manipulation, with increased fluid intake and increased ingestion of fiber, whether via natural sources such as fruits and vegetables or via supplements containing more purified forms of fiber. […] Opioid-induced constipation (OIC) is a common adverse effect of opioid use. […] Medications to treat OIC and provide analgesia have been approved by the FDA. […] Methylnaltrexone (Relistor) is a PAMORA indicated for opioid-induced constipation in adults with chronic noncancer pain. […] Naldemedine (Symproic), another PAMORA, was approved by the FDA in March 2017 for opioid-induced constipation in adults with noncancer pain.

• #41 Opioid-Induced Constipation: Clinical Guidance and Approved Therapies

  https://www.uspharmacist.com/article/opioidinduced-constipation-clinical-guidance-and-approved-therapies

  General consensus is that, in addition to lifestyle changes, stimulant laxatives should be initiated with opioid treatment to prevent OIC. […] When the combination of diet, lifestyle, and OTC laxatives and stool softeners is insufficient to relieve OIC, most clinicians and patients turn to prescription medications. Four prescription products are approved for OIC in adults with chronic noncancer pain: lubiprostone, methylnaltrexone, naloxegol, and naldemedine. […] OIC is a common side effect of long-term opioid use. This condition may affect the patients activities of daily living. To achieve optimal results, healthcare providers should be familiar with the many different nonpharmacologic and pharmacologic therapies that are available for OIC management.

• #42 Constipation Treatment & Management: Approach Considerations, Dietary Measures, Pharmacologic Therapy

  https://emedicine.medscape.com/article/184704-treatment

  The first-line therapy remains dietary manipulation, with increased fluid intake and increased ingestion of fiber, whether via natural sources such as fruits and vegetables or via supplements containing more purified forms of fiber. […] Opioid-induced constipation (OIC) is a common adverse effect of opioid use. […] Medications to treat OIC and provide analgesia have been approved by the FDA. […] Methylnaltrexone (Relistor) is a PAMORA indicated for opioid-induced constipation in adults with chronic noncancer pain. […] Naldemedine (Symproic), another PAMORA, was approved by the FDA in March 2017 for opioid-induced constipation in adults with noncancer pain.

• #43 Opioid-induced Constipation: Old and New Concepts in Diagnosis and Treatment

  https://www.jnmjournal.org/journal/view.html?volume=30&number=2&spage=131

  Standard laxatives are a class of drugs that can cause laxation according to different mechanisms of action. […] The use of osmotic laxatives is recommended as a first line of treatment in OIC. […] When the therapeutic response is inadequate or absent, increasing the dose or adding a second laxative with a different mechanism of action (for example, a stimulant laxative) is suggested before moving on to second-line treatment. […] Peripherally acting -opioid receptor antagonists (PAMORAs) selectively block -receptors in the gastrointestinal tract, antagonizing the side effects of opioid drugs. […] The use of naldemedine, naloxegol, and methylenexone is approved by the EMA for treating OIC in patients who have not had a satisfactory clinical response to standard laxatives. […] Opioid therapy has several side effects on digestive functions that can alter bowel habits and defecator patterns. […] In practice, a stepwise approach is highly recommended, starting with lifestyle changes, then osmotic laxatives as first-line therapy, and adding a second laxative if a single one is insufficient.

• #44 Constipation – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/constipation/diagnosis-treatment/drc-20354259

  Treatment for constipation usually begins with diet and lifestyle changes meant to increase the speed at which stool moves through the colon. Also, your health care professional may change the medicines you take if they may be causing or worsening constipation. If those changes don’t help, other treatments may be necessary. […] Your doctor may recommend the following changes to relieve your constipation: […] Prunes, also called dried plums, have long been used to treat or prevent constipation. Prunes are a good source of fiber, but they also have naturally present agents that draw fluids into the colon. […] Laxatives are medicines that help move stool through the colon. Each laxative works somewhat differently. The following are available without prescriptions: […] An enema is a fluid gently pumped into the rectum to help pass stool. An enema may be used when other treatments don’t work.

• #45 Constipation & Defecation Problems | ACG

  https://gi.org/topics/constipation-and-defection-problems/

  Constipation is one of the most frequent gastrointestinal complaints in the USA and Western countries. There are at least 2.5 million doctor visits for constipation in the USA each year, and hundreds of millions of dollars are spent on laxatives yearly. […] When stool is hard, tap water enemas are used. The patient is asked to lay on their left side, with knees flexed. About 5 to 10 ounces of water, at body temperature, is gently introduced into the rectum and sigmoid colon. The hard stool gets softened and comes out with the water. Non-prescription prepackaged enemas can be used in place of tap water. If enemas fail to work, a health care worker may need to remove the stool manually using a gloved finger. The person is then sometimes asked to drink a solution containing dissolved salts and polyethylene glycol, which cleanses the digestive tract.

• #46 Constipation | NHS inform

  https://www.nhsinform.scot/illnesses-and-conditions/stomach-liver-and-gastrointestinal-tract/constipation/

  Laxatives are a type of medicine that help you pass stools. […] Your pharmacist will usually start you on a bulk-forming laxative. […] If your stools remain hard after you’ve taken a bulk-forming laxative, your pharmacist may prescribe an osmotic laxative instead. […] If your stools are soft, but you still have difficulty passing them, your pharmacist may recommend a stimulant laxative. […] If you’ve had constipation for a short time, your pharmacist will usually advise you to stop taking the laxative once your stools are soft and easily passed. […] However, if your constipation is caused by an underlying medical condition or a medicine you’re taking, your GP may advise you to take laxatives for much longer, possibly many months or even years. […] Faecal impaction is usually treated with laxative medication, although suppositories and mini enemas may sometimes be used.

• #47 Constipation Relief: Quick Home Remedies

  https://www.healthline.com/health/digestive-health/how-to-make-yourself-poop

  Osmotic laxatives work slightly differently than stimulant laxatives. They help move fluids through the colon. […] A stool softener, such as docusate sodium (Colace) or docusate calcium (Surfak), can moisten the stool by pulling water from your intestines. […] Enemas work by softening stool enough to produce a bowel movement. […] Rectal suppositories inserted into the rectum can soften stool and help encourage bowel movements. […] Light exercises like walking or yoga can encourage bowel movements by increasing blood flow throughout your abdomen. […] Manually massaging the colon may help stimulate the bowels for people whose constipation is caused by the slow movement of stool through the colon. […] Natural remedies like probiotics may help treat and prevent constipation. […] If your constipation lasts more than a week and doesn’t respond to treatment, a doctor may be able to rule out serious causes and find an effective treatment. […] Home remedies include increasing your fiber intake or taking a laxative, using a suppository, or taking a stool softener.

• #48 Constipation Relief: Quick Home Remedies

  https://www.healthline.com/health/digestive-health/how-to-make-yourself-poop

  Osmotic laxatives work slightly differently than stimulant laxatives. They help move fluids through the colon. […] A stool softener, such as docusate sodium (Colace) or docusate calcium (Surfak), can moisten the stool by pulling water from your intestines. […] Enemas work by softening stool enough to produce a bowel movement. […] Rectal suppositories inserted into the rectum can soften stool and help encourage bowel movements. […] Light exercises like walking or yoga can encourage bowel movements by increasing blood flow throughout your abdomen. […] Manually massaging the colon may help stimulate the bowels for people whose constipation is caused by the slow movement of stool through the colon. […] Natural remedies like probiotics may help treat and prevent constipation. […] If your constipation lasts more than a week and doesn’t respond to treatment, a doctor may be able to rule out serious causes and find an effective treatment. […] Home remedies include increasing your fiber intake or taking a laxative, using a suppository, or taking a stool softener.

• #49 Constipation | NHS inform

  https://www.nhsinform.scot/illnesses-and-conditions/stomach-liver-and-gastrointestinal-tract/constipation/

  Laxatives are a type of medicine that help you pass stools. […] Your pharmacist will usually start you on a bulk-forming laxative. […] If your stools remain hard after you’ve taken a bulk-forming laxative, your pharmacist may prescribe an osmotic laxative instead. […] If your stools are soft, but you still have difficulty passing them, your pharmacist may recommend a stimulant laxative. […] If you’ve had constipation for a short time, your pharmacist will usually advise you to stop taking the laxative once your stools are soft and easily passed. […] However, if your constipation is caused by an underlying medical condition or a medicine you’re taking, your GP may advise you to take laxatives for much longer, possibly many months or even years. […] Faecal impaction is usually treated with laxative medication, although suppositories and mini enemas may sometimes be used.

• #50 Constipation – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/constipation/diagnosis-treatment/drc-20354259

  Your health care professional may prescribe other medicines if other treatments don’t work. […] Biofeedback training involves working with a therapist who uses devices to help you learn to relax muscles and coordinate the use of muscles in your pelvis, rectum and anus. […] Surgery may be necessary to correct damage or irregularities in the tissues or nerves of the colon or rectum. Surgery is usually done only when other treatments for chronic constipation haven’t worked.

• #51 Treating constipation with biofeedback for the pelvic floor – Harvard Health

  https://www.health.harvard.edu/blog/treating-constipation-with-biofeedback-for-the-pelvic-floor-2019051616638

  Constipation is often clinically defined as having three or fewer bowel movements a week. […] When constipation is a problem, there are two main reasons for it: slow movement of the colon and pelvic floor dysfunction. Treatment for slowed movement of the colon is usually laxatives and drugs to move your colon. But getting your pelvic floor evaluated is worthwhile, because a diagnosis of pelvic floor dysfunction typically involves nondrug treatment. […] The good news is that treatment typically does not involve medications. Instead, treatment involves physical therapy in the form of biofeedback. […] By doing this, you receive feedback (either visual or verbal) on what you are doing with your abdominal wall muscles and anal sphincter during a bowel movement. […] The physical therapist will also discuss dietary recommendations including increased water and fiber consumption, positioning techniques (like using a Squatty Potty), or massaging your abdomen to stimulate the gut. […] Retraining your body to change the way you have a bowel movement takes time. But it could potentially help with all of the symptoms of constipation.

• #52 Constipation: Symptoms & Causes

  https://my.clevelandclinic.org/health/diseases/4059-constipation

  A few prescription drugs are available to treat constipation. These include: Lubiprostone (Amitiza), Prucalopride (Prudac, Motegrity), Plecanatide (Trulance), Lactulose (Cephulac, Kristalose), Linaclotide (Linzess). […] Surgery is rarely needed to treat constipation. But your healthcare provider may recommend surgery if a structural problem in your colon is causing constipation. Examples of these problems include: A blockage in your colon (intestinal obstruction), A narrowing in a portion of your intestine (intestinal stricture), A tear in your anus (anal fissure), The collapse of part of your rectum into your vagina (rectal prolapse). […] Use the same home-based methods you used to treat constipation to prevent it from becoming a chronic problem: Eat a well-balanced diet with plenty of fiber. Good sources of fiber are fruits, vegetables, legumes, and whole-grain breads and cereals. Fiber and water help your colon pass stool. […] Call a healthcare provider if: Constipation is a new problem for you, You see blood in your poop, Youre losing weight unintentionally, You have severe pain with bowel movements, Your constipation has lasted more than three weeks, You have symptoms of outlet dysfunction constipation.

• #53 Constipation Treatment & Management: Approach Considerations, Dietary Measures, Pharmacologic Therapy

  https://emedicine.medscape.com/article/184704-treatment

  Chronic constipation that responds poorly to laxatives may be due to the use of drugs such as opioids or from defecation disorders and advanced colonic dysmotility. […] The FDA approved prucalopride, a serotonin-4 receptor agonist indicated for chronic idiopathic constipation (CIC), in December 2018. […] Lubiprostone and linaclotide are FDA approved for chronic idiopathic constipation and constipation caused by irritable bowel syndrome (IBS). […] Surgical care is generally restricted to the evaluation of underlying causes, such as large bowel obstruction, volvulus, or intra-abdominal infection or ischemia. […] There is increasing interest in the use of sacral nerve stimulation in carefully selected patients with severe refractory constipation. […] First-line treatment is fiber supplementation, increased water intake, gentle exercise, and occasional laxative use as required.

• #54 Chronic constipation: Update on management | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/84/5/397

  Lubiprostone and linaclotide are approved by the US Food and Drug Administration (FDA) for both constipation and constipation-predominant irritable bowel syndrome. […] Biofeedback therapy involves an instrument-based auditory or visual tool to help patients coordinate abdominal, rectal, puborectalis, and anal sphincter muscles and produce a propulsive force using their abdominal muscles to achieve complete evacuation. […] Surgery for constipation is reserved for patients who continue to have symptoms despite optimal medical therapy. […] Total abdominal colectomy with ileorectal anastomosis is a surgical option for medically intractable slow-transit constipation. […] Stapled transanal resection involves circumferential transanal stapling of the redundant rectal mucosa.

• #55 Constipation Diagnosis & Treatment | Brigham and Women’s Hospital

  https://www.brighamandwomens.org/surgery/general-and-gastrointestinal-surgery/colorectal-and-intestines-disorders/constipation

  Board certified colon and rectal surgeons at Brigham and Womens Hospital (BWH) offer the most advanced minimally invasive surgery approaches for patients with constipation, including laparoscopic options. […] For select patients with severe constipation symptoms caused by colonic inertia, our colon and rectal surgeons at BWH offer unmatched experience in these surgical options: Total Colectomy, or colorectal resection, the surgical removal (resection) of the large intestine with ileorectal anastomosis or hookup of the small intestine to the rectum. Colon and rectal surgeons at BWH specialize in laparoscopic colectomy surgery, a minimally invasive approach with small incisions. […] Constipation can often be treated through dietary and lifestyle changes. Treatment may include: Diet modifications, Laxatives, Medication changes, Biofeedback. […] Careful monitoring and the involvement of an experienced colon and rectal surgeon are important to the successful outcome for patients with colorectal conditions.

• #56 Constipation: Symptoms & Causes

  https://my.clevelandclinic.org/health/diseases/4059-constipation

  A few prescription drugs are available to treat constipation. These include: Lubiprostone (Amitiza), Prucalopride (Prudac, Motegrity), Plecanatide (Trulance), Lactulose (Cephulac, Kristalose), Linaclotide (Linzess). […] Surgery is rarely needed to treat constipation. But your healthcare provider may recommend surgery if a structural problem in your colon is causing constipation. Examples of these problems include: A blockage in your colon (intestinal obstruction), A narrowing in a portion of your intestine (intestinal stricture), A tear in your anus (anal fissure), The collapse of part of your rectum into your vagina (rectal prolapse). […] Use the same home-based methods you used to treat constipation to prevent it from becoming a chronic problem: Eat a well-balanced diet with plenty of fiber. Good sources of fiber are fruits, vegetables, legumes, and whole-grain breads and cereals. Fiber and water help your colon pass stool. […] Call a healthcare provider if: Constipation is a new problem for you, You see blood in your poop, Youre losing weight unintentionally, You have severe pain with bowel movements, Your constipation has lasted more than three weeks, You have symptoms of outlet dysfunction constipation.

• #57 Constipation Treatment & Management: Approach Considerations, Dietary Measures, Pharmacologic Therapy

  https://emedicine.medscape.com/article/184704-treatment

  Chronic constipation that responds poorly to laxatives may be due to the use of drugs such as opioids or from defecation disorders and advanced colonic dysmotility. […] The FDA approved prucalopride, a serotonin-4 receptor agonist indicated for chronic idiopathic constipation (CIC), in December 2018. […] Lubiprostone and linaclotide are FDA approved for chronic idiopathic constipation and constipation caused by irritable bowel syndrome (IBS). […] Surgical care is generally restricted to the evaluation of underlying causes, such as large bowel obstruction, volvulus, or intra-abdominal infection or ischemia. […] There is increasing interest in the use of sacral nerve stimulation in carefully selected patients with severe refractory constipation. […] First-line treatment is fiber supplementation, increased water intake, gentle exercise, and occasional laxative use as required.

• #58 Constipation | NHS inform

  https://www.nhsinform.scot/illnesses-and-conditions/stomach-liver-and-gastrointestinal-tract/constipation/

  If you’re pregnant, there are ways for you to safely treat constipation without harming you or your baby. […] Your pharmacist will first advise you to change your diet by increasing fibre and fluid intake. […] If dietary and lifestyle changes don’t work, you may be prescribed a laxative to help you pass stools more regularly. […] For children, laxatives are often recommended alongside changes to diet. […] Osmotic laxatives are usually tried first, followed by a stimulant laxative if necessary. […] Constipation rarely causes any complications or long-term health problems. Treatment is usually effective, particularly if it’s started promptly. […] Long-term constipation can increase the risk of faecal impaction, which is where dried, hard stools collect in your rectum and anus. […] Faecal impaction is usually treated with laxative medication, although suppositories and mini enemas may sometimes be used.

• #59

  https://www.healthychildren.org/English/health-issues/conditions/abdominal/Pages/constipation.aspx

  How is constipation treated? Many treatments and strategies exist to help children manage their constipation. While some of these medicines are over the counter, we recommend that you discuss any treatments with your child’s doctor before starting. Let’s look at some of these options: […] Diet There is no specific „constipation diet” that has been shown to be effective in preventing or treating constipation. However, increasing water intake and the use of natural fibers from fruits and vegetables are a healthy option that can be recommended to children. […] Hydration Making sure that children drink enough water every day is crucial to many bodily functions. When the body does not get enough water, it becomes dehydrated and takes water from the gut and pushes it to other important places in the body, like the heart. This can be what starts the cycle to make poops harder. Increasing a child’s water intake without medicines is not an effective treatment for constipation.

• #60 Constipation in Children: Symptoms, Treatment and Resources | Nationwide Children’s Hospital

  https://www.nationwidechildrens.org/conditions/constipation

  Many children have constipation at one time or another. […] Chronic constipation usually develops over months or years. Most children need at least six months of therapy and having regular bowel movements before they can be weaned from the therapy without a relapse. […] Nationwide Children’s Hospital offers treatment for constipation in multiple specialty programs. […] Treatment for constipation and soiling has three phases clean out, maintenance, and reestablishing toileting behaviors. […] The clean-out phase is designed to clear the stool plug out of the colon. […] Once your child’s stool is soft, your doctor or nurse practitioner may suggest that you add other medicines by mouth or rectum. […] Once the clean-out phase is complete, your doctor or nurse practitioner will tell you what medicine your child will take every day. […] Children with soiling or more severe constipation usually require medication. […] Once your child is having soft, comfortable bowel movements on a regular basis, the next step is to get their regular toileting schedule back on track.

• #61 Pediatric Constipation Treatment & Management: Approach Considerations, Colon Evacuation, Removal of Pain-Associated Defecation

  https://emedicine.medscape.com/article/928185-treatment

  Aggressive use of oral cathartics such as polyethylene glycol, sodium phosphate, magnesium citrate, or a balanced electrolyte solution with polyethylene glycol or a series of enemas can accomplish disimpaction. […] Once the colon has been evacuated, chronic laxative therapy is generally required. Virtually any laxative can be used as long as it is used in sufficient quantity to produce 1-2 soft stools daily. […] Continuing laxative therapy for a number of months is often necessary. As a result, it is very important to reassure caregivers that long-term laxative usage is safe. […] In many cases, long-term success in the management of constipation depends on the child establishing regular and routine toilet times. […] Dietary changes, such as increasing the child’s intake of fluids and carbohydrates, are commonly recommended as part of the treatment of constipation.

• #62

  https://www.healthychildren.org/English/health-issues/conditions/abdominal/Pages/constipation.aspx

  Constipation action plans There is research showing that children and parents benefit from receiving a Constipation Action Plan at the time of diagnosis. These plans help parents understand what amounts (doses) of medicines to give at what times, and, if need be, to give larger doses in response to worsening symptoms. […] How long does my child need to take their medicines for constipation? Some children may need a medical disimpaction (or cleanout) before starting maintenance therapy. If this is the case, there is a 3-step process to treatment: […] Step 1: The initial cleanout removes the backed-up poop from the body. […] Step 2: Maintenance (daily) therapy prevents stool build-up by keeping stool soft thus cutting down on withholding behavior and allowing the colon to return to its normal shape and muscle tone.

• #63 Food as Medicine: Food Therapy for Constipation | Children’s Hospital of Philadelphia

  https://www.chop.edu/health-resources/food-medicine-food-therapy-constipation

  Many children have constipation. Nutrition and other lifestyle changes can support a healthy gut throughout your child’s life. […] How can I treat constipation through nutrition and lifestyle changes? Drink enough fluid. Include high-fiber foods in the diet. Add nutrition supplements, with the help of your healthcare provider. Eat and drink on a regular schedule. Be physically active. Find time each day to relax and avoid rushing when sitting on the toilet. Mornings and after a meal may be a good time to practice toilet sitting. […] Fiber adds bulk to stool and pulls water into the intestines, making stools soft and easy to pass. It is important to drink enough fluid to allow the fiber to work. Fiber also helps keep the bacteria in the gut healthy! […] Include a fiber-rich food in every meal and snack. Build up intake slowly to avoid gassiness. Fruits and vegetables like apples, pears, and cucumbers that have a fibrous but tasty skin are good choices.

• #64 Constipation in Children: Symptoms, Treatment and Resources | Nationwide Children’s Hospital

  https://www.nationwidechildrens.org/conditions/constipation

  Many children have constipation at one time or another. […] Chronic constipation usually develops over months or years. Most children need at least six months of therapy and having regular bowel movements before they can be weaned from the therapy without a relapse. […] Nationwide Children’s Hospital offers treatment for constipation in multiple specialty programs. […] Treatment for constipation and soiling has three phases clean out, maintenance, and reestablishing toileting behaviors. […] The clean-out phase is designed to clear the stool plug out of the colon. […] Once your child’s stool is soft, your doctor or nurse practitioner may suggest that you add other medicines by mouth or rectum. […] Once the clean-out phase is complete, your doctor or nurse practitioner will tell you what medicine your child will take every day. […] Children with soiling or more severe constipation usually require medication. […] Once your child is having soft, comfortable bowel movements on a regular basis, the next step is to get their regular toileting schedule back on track.

• #65 Management of Constipation in Older Adults | AAFP

  https://www.aafp.org/pubs/afp/issues/2015/0915/p500.html

  Chronic constipation is common in adults older than 60 years, and symptoms occur in up to 50% of nursing home residents. Primary constipation is also referred to as functional constipation. Secondary constipation is associated with chronic disease processes, medication use, and psychosocial issues. Fecal impaction should be treated with mineral oil or warm water enemas. Most patients are initially treated with lifestyle modifications, such as scheduled toileting after meals, increased fluid intake, and increased dietary fiber intake. Additional fiber intake in the form of polycarbophil, methylcellulose, or psyllium may improve symptoms. Fiber intake should be slowly increased over several weeks to decrease adverse effects. The next step in the treatment of constipation is the use of an osmotic laxative, such as polyethylene glycol, followed by a stool softener, such as docusate sodium, and then stimulant laxatives. Long-term use of magnesium-based laxatives should be avoided because of potential toxicity. If symptoms do not improve, a trial of linaclotide or lubiprostone may be appropriate, or the patient may be referred for further diagnostic evaluation. Peripherally acting mu-opioid antagonists are effective for opioid-induced constipation but are expensive.

• #66 Constipation Treatment & Management: Approach Considerations, Dietary Measures, Pharmacologic Therapy

  https://emedicine.medscape.com/article/184704-treatment

  Manual disimpaction and transrectal enemas may be used after any critical illness associated with constipation has been ruled out. […] Medical care should focus on dietary change and exercise rather than laxatives, enemas, and suppositories, none of which really address the underlying problem. […] The key to treating most patients with constipation is correction of dietary deficiencies. […] Surgical care is generally restricted to the evaluation of underlying causes or the management of acute complications of constipation. […] Once acute constipation has resolved and the associated medical or surgical conditions have been ruled out, additional inpatient care is rarely indicated. […] An international expert consensus (Delphi Survey) established five symptoms and their severities to define treatment failure to provide adequate relief in patients with chronic constipation.

• #67 Constipation and Cancer – Side Effects – NCI

  https://www.cancer.gov/about-cancer/treatment/side-effects/constipation

  Drinking plenty of fluids and being physically active can help prevent and treat constipation. […] Your doctor can recommend medicines and other ways for treating constipation caused by cancer and cancer treatment. […] If your doctor thinks your cancer or cancer treatments will cause constipation, they will give you tips and prescribe medicine to prevent it. If you become constipated, your doctor will recommend many of these same tips and medicines to help you get relief. Talk with your health care team about what treatment is right for you. […] Your doctor may prescribe medicines called laxatives that help prevent or relieve constipation. Use only medicines and treatments for constipation that your doctor recommends. […] The main treatment for fecal impaction is to moisten and soften the stool using an enema. The softened stool can then pass out of the body.

• #68 What Is Constipation? | Signs of Constipation | American Cancer Society

  https://www.cancer.org/cancer/managing-cancer/side-effects/stool-or-urine-changes/constipation.html

  Constipation is usually caused by more than one factor. The more risk factors you have, the more likely you are to have constipation. […] The main goal of treating constipation is to have regular, comfortable bowel movements. What you eat has a big effect on your bowels, so many people start there when managing constipation. […] Getting 20 to 35 grams of insoluble fiber in your diet every day is one of the best ways to prevent and manage constipation. […] Laxatives can be habit-forming and shouldn’t be used long-term. Always check with your doctor or cancer care team before starting a laxative, even if they’re over the counter. […] Enemas and suppositories are often used for short-term relief of constipation and sometimes work faster than medicines taken by mouth. […] For long-term (chronic) constipation that doesn’t get better with other treatments, prescription medicines are sometimes used.

• #69 Constipation | Causes, Symptoms, Treatment & Support | Guts UK

  https://gutscharity.org.uk/advice-and-information/symptoms/constipation/

  Regular use of laxatives is generally not encouraged but occasional use is not harmful. […] The balance of scientific evidence suggests that laxatives prescribed by a doctor do not cause long-term damage to the bowel. […] If you have tried laxatives and diet changes, and you are still constipated, ask your doctor about: […] Newer medicines can be helpful for some people who don’t tolerate or don’t respond to simple laxatives. […] Biofeedback. This involves training to help the person co-ordinate rectal and abdominal muscles better. […] Behavioural treatment such as Cognitive Behavioural Therapy (CBT) and hypnotherapy. […] Transanal Irrigation. This is a treatment that may be helpful for people with chronic constipation. […] Surgery is very rarely considered in the treatment of constipation. […] Any sudden change in your symptoms should be reported to your doctor.

• #70 Pediatric Constipation Treatment & Management: Approach Considerations, Colon Evacuation, Removal of Pain-Associated Defecation

  https://emedicine.medscape.com/article/928185-treatment

  In infants and young children, it is appropriate to consider removing cow-milk protein from the diet for a period is appropriate, because chronic constipation may be precipitated by ingestion of cow-milk proteins. […] Consultation with a pediatric gastroenterologist or pediatric surgeon is appropriate if the child’s history or examination findings suggest an underlying organic cause (eg, Hirschsprung disease). […] Assessment of constipation after disimpaction assures that the prescribed therapy was effective. […] Functional constipation is an inability to pass stool or difficulty with passing stool regularly and efficiently. […] In June 2023, the US Food and Drug Administration (FDA) approved linaclotide (Linzess) as the first treatment for pediatric functional constipation. […] A study by Sharifi-Rad et al that included 90 children reported treatment success with interferential electrical stimulation as an adjuvant therapy for functional constipation.

• #71 Constipation: Symptoms & Causes

  https://my.clevelandclinic.org/health/diseases/4059-constipation

  A few prescription drugs are available to treat constipation. These include: Lubiprostone (Amitiza), Prucalopride (Prudac, Motegrity), Plecanatide (Trulance), Lactulose (Cephulac, Kristalose), Linaclotide (Linzess). […] Surgery is rarely needed to treat constipation. But your healthcare provider may recommend surgery if a structural problem in your colon is causing constipation. Examples of these problems include: A blockage in your colon (intestinal obstruction), A narrowing in a portion of your intestine (intestinal stricture), A tear in your anus (anal fissure), The collapse of part of your rectum into your vagina (rectal prolapse). […] Use the same home-based methods you used to treat constipation to prevent it from becoming a chronic problem: Eat a well-balanced diet with plenty of fiber. Good sources of fiber are fruits, vegetables, legumes, and whole-grain breads and cereals. Fiber and water help your colon pass stool. […] Call a healthcare provider if: Constipation is a new problem for you, You see blood in your poop, Youre losing weight unintentionally, You have severe pain with bowel movements, Your constipation has lasted more than three weeks, You have symptoms of outlet dysfunction constipation.

• #72 Constipation | Causes, Symptoms, Treatment & Support | Guts UK

  https://gutscharity.org.uk/advice-and-information/symptoms/constipation/

  Regular use of laxatives is generally not encouraged but occasional use is not harmful. […] The balance of scientific evidence suggests that laxatives prescribed by a doctor do not cause long-term damage to the bowel. […] If you have tried laxatives and diet changes, and you are still constipated, ask your doctor about: […] Newer medicines can be helpful for some people who don’t tolerate or don’t respond to simple laxatives. […] Biofeedback. This involves training to help the person co-ordinate rectal and abdominal muscles better. […] Behavioural treatment such as Cognitive Behavioural Therapy (CBT) and hypnotherapy. […] Transanal Irrigation. This is a treatment that may be helpful for people with chronic constipation. […] Surgery is very rarely considered in the treatment of constipation. […] Any sudden change in your symptoms should be reported to your doctor.

• #73 Treatment for Constipation – NIDDK

  https://www.niddk.nih.gov/health-information/digestive-diseases/constipation/treatment

  If self-care treatments dont work, your doctor may prescribe a medicine to treat your constipation. […] Your doctor may prescribe one of the following medicines for constipation […] If you have problems with the muscles that control bowel movements, your doctor may recommend biofeedback therapy to retrain your muscles. […] Your doctor may recommend surgery to treat an anorectal blockage caused by rectal prolapse if other treatments dont work. […] You can help prevent constipation by doing some of the same things that treat constipation.

• #74 Constipation – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/154

  Constipation is initially evaluated with a detailed history and physical examination, including a digital rectal examination. […] Initial treatment consists of lifestyle modification and laxatives. […] Medical treatment should be tailored to the underlying aetiology. If the constipation does not respond to medical treatment, patients may need specialised evaluation for pelvic floor dysfunction and biofeedback therapy. Surgery is only rarely indicated.

• #75 Nonprescription laxatives for constipation: Use with caution

  https://www.mayoclinic.org/diseases-conditions/constipation/in-depth/laxatives/art-20045906

  Oral laxatives can change how your body absorbs some medicines and nutrients. After long-term use, some laxatives can lead to an electrolyte imbalance or other serious health issues. […] Using laxatives incorrectly can cause serious health conditions. If you need laxatives to have a bowel movement, talk to your healthcare team. They will guide you on how to slowly withdraw from them. This should restore your colon’s natural ability to contract.

• #76

  https://www.nhs.uk/conditions/laxatives/

  In some cases, you may be prescribed a laxative to use regularly, but this should always be supervised by a GP or gastroenterologist (a specialist in gut problems). […] Like most medicines, laxatives can cause side effects. […] Using laxatives too often or for too long can also cause diarrhoea, the bowel becoming blocked by large, dry poo (intestinal obstruction), and unbalanced salts and minerals in your body. […] It’s often possible to improve constipation without using laxatives.

• #77 Constipation | NHS inform

  https://www.nhsinform.scot/illnesses-and-conditions/stomach-liver-and-gastrointestinal-tract/constipation/

  If you’re pregnant, there are ways for you to safely treat constipation without harming you or your baby. […] Your pharmacist will first advise you to change your diet by increasing fibre and fluid intake. […] If dietary and lifestyle changes don’t work, you may be prescribed a laxative to help you pass stools more regularly. […] For children, laxatives are often recommended alongside changes to diet. […] Osmotic laxatives are usually tried first, followed by a stimulant laxative if necessary. […] Constipation rarely causes any complications or long-term health problems. Treatment is usually effective, particularly if it’s started promptly. […] Long-term constipation can increase the risk of faecal impaction, which is where dried, hard stools collect in your rectum and anus. […] Faecal impaction is usually treated with laxative medication, although suppositories and mini enemas may sometimes be used.

• #78 Constipation – symptoms and treatment | healthdirect

  https://www.healthdirect.gov.au/constipation

  Drink plenty of water and other fluids. […] Get regular physical activity. […] Go to the toilet when you need to, without delaying. […] Learn and use relaxation techniques to manage stress. […] If these measures don’t work, ask your doctor or pharmacist for advice. They might need to check the medicines you take or recommend a laxative to get your bowel moving. […] Laxatives can be used to treat constipation. […] Your doctor or pharmacist will talk with you about which laxative may be best for your episode of constipation. […] If you don’t notice an improvement in your constipation, talk to your doctor about other possible treatments. […] There is a prescription medicine available to treat chronic (ongoing) constipation that has not responded to laxatives. […] You can help prevent constipation by practising good toilet habits. […] Always go to the toilet when you get the urge to do a poo don’t ignore it or wait until later. […] Make sure that you use the correct sitting position when you’re on the toilet.

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