Medical Therapy of Constipation: Current Standards and Beyond (original) (raw)
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Management of chronic constipation
Inpharma Weekly, 2003
Introduction: Constipation is considered to be one of the commonly encountered clinical conditions around the world. The worldwide prevalence of idiopathic constipation has been approximated to be about fourteen percent. In North America alone, the overall prevalence of chronic constipation was estimated to reach eight percent, disproportionately affecting females more than males and older individuals more than younger individuals. This is likely to be caused by the higher rate of self-reporting of clinical manifestations and the higher rates of injuries to the pelvic floor muscles among females, along with the higher rates of the presence of other comorbidities and in the elderly and the fact that they use many medications. In addition, older individuals are generally more vulnerable to late complications that can potentially follow constipation. Constipation is generally more common in North American countries and European countries, when compared to other Asian countries, possibly because of the presence of cultural diversities, dietary variations, genetic predisposition, and environmental factors. Although constipation is commonly encountered condition, only a third of patients with chronic constipation get a consult from an expert regarding their manifestations. Most patients with constipation tend to manage their clinical manifestations sufficiently with nonpharmacological or lifestyle interventions. On the other hand, other patients with chronic constipation can have clinical manifestations which could be challenging to treat with these simple approaches, and these patients are generally vulnerable to suffer from significant health impairments and decreased quality of life along with psychological distress associated with their GI manifestations. Like other functional GI conditions, chronic constipation could significantly affect productivity and functionality of the patient and lead to declines in social activities of affected patients. In addition, chronic constipation is considered to be associated with high costs on healthcare resources. It is, in fact, approximated that the costs of testing for diagnosing constipation is about 7billioneveryyear,withadditional7 billion every year, with additional 7billioneveryyear,withadditional500 million to be spent on drugs and other therapies. In the following discussion, we will review the pathophysiology and common causes of constipation, the role of diagnostic tests, and the evidence regarding available medical options for this common condition..Aim of work: In this review, we will discuss Management of chronic constipation. Methodology: We did a systematic search for Management of chronic constipation using PubMed search engine (http://www.ncbi.nlm.nih.gov/) and Google Scholar search engine (https://scholar.google.com). All relevant studies were retrieved and discussed. We only included full articles.Conclusions: Chronic constipation is a common health problem that has great importance. Clinicians must have great understanding of the common underlying etiologies and pathophysiologies that cause chronic constipation and be able to distinguish between different types of constipation through proper history obtaining, complete physical examination, and the use of available testing modalities. Several therapeutic interventions are generally used for the medical management of constipation, and physicians should modify treatment plans according to the most likely etiology, patients' response, and the presence of concomitant symptoms. Some experts recommend a step-wise approach for the management of constipation, starting treatment with lifestyle modifications and bulking pharmacological agents, continuing to over-the-counter laxatives, and then to prescription agents in refractory cases. There are sometimes in everyday practice when the use of combination therapy might be needed to improve patients' manifestations and quality of life, but this has not been well-studied or published in the medical literature to provide solid guidelines. Newer agents that have shown promising results in clinical trials and practice are now available, and additional new drugs are in different stages of development.
The Treatment of Chronic Constipation in Adults
Journal of General Internal Medicine, 1997
OBJECTIVE: To evaluate whether laxatives and fiber therapies improve symptoms and bowel movement frequency in adults with chronic constipation. DATA SOURCES: English language studies were identified from computerized MEDLINE (1966-1995), Biological Abstracts (1990-1995), and Micromedex searches; bibliographies; textbooks; laxative manufacturers; and experts. STUDY SELECTION: Randomized trials of laxative or fiber therapies lasting more than 1 week that evaluated clinical outcomes in adults with chronic constipation MEASUREMENTS AND MAIN RESULTS: Two independent reviewers appraised each trial's characteristics including methodologic quality. There were 36 trials involving 1,815 persons from a variety of settings including clinics, hospitals and nursing homes. Twenty-three trials were 1 month or less in duration. Several laxative and fiber preparations were evaluated. Twenty trials had a placebo, usual care, or discontinuation of laxative control group, and 16 directly compared different agents. Laxatives and fiber increased bowel movement frequency by an overall weighted average of 1.4 (95% confidence interval [CI] 1.1-1.8) bowel movements per week. Fiber and bulk laxatives decreased abdominal pain and improved stool consistency compared with placebo. Most nonbulk laxative data concerning abdominal pain and stool consistency were inconclusive, though cisapride, lactulose, and lactitol improved consistency. Data concerning superiority of various treatments were inconclusive. No severe side effects for any of the therapies were reported. CONCLUSIONS: Both fiber and laxatives modestly improved bowel movement frequency in adults with chronic constipation. There was inadequate evidence to establish whether fiber was superior to laxatives or one laxative class was superior to another.
Chronic constipation and treatment options (Review)
Molecular Medicine Reports, 2013
Chronic constipation (CC) is a highly prevalent heterogeneous disorder. Although CC is not known to be associated with the development of serious disease or with excess mortality, it considerably reduces the patients quality of life. In addition, it represents an economic burden to patients and society. The majority of patients with CC successfully manage the disorder by dietary management and the use of laxatives. Patients with functional CC (slow-transit and non-slow transit constipation) do not respond to laxatives and are a small fraction of the total population complaining of constipation. Regardless of the low number of these patients, the intractability of their symptoms causes psychological and social stress and greatly impairs their quality of life. Furthermore, these patients consume a disproportionate quantity of medical resources. It appears that these patients have a disturbance in the serotonin transmission system, which results in a cascade of alterations in a number of gut neuroendocrine hormones/transmitters. The effect of prucalopride, a serotonin receptor agonist, in this category of patients appears to be not only a pharmacological prokinetic action, but also a correction of a pre-existing disturbance. Linaclotide, a member of the guanylin peptide family, binds to the ligand-binding region of guanylate cyclase-C on the luminal surface of gastrointestinal epithelia resulting in increased fluid secretion. This drug has also been found to be effective for the treatment of functional CC. In addition, biofeedback and sacral nerve stimulation are effective in the treatment of CC caused by pelvic floor disorders. Contents 1. Introduction 2. Definition and types of constipation 3. Possible mechanisms for functional constipation 4. Treatment options 5. Conclusion
Diagnosis and treatment of constipation: a clinical update based on the Rome IV criteria
Journal of Coloproctology, 2018
The aim of this study was to evaluate the published professional association guidelines regarding the current diagnosis and treatment of functional intestinal constipation in adults and to compare those guidelines with the authors’ experience to standardize actions that aid clinical reasoning and decision-making for medical professionals. A literature search was conducted in the Medline/PubMed, Scielo, EMBASE and Cochrane online databases using the following terms: chronic constipation, diagnosis, management of chronic constipation, Roma IV and surgical treatment. Conclusively, chronic intestinal constipation is a common condition in adults and occurs most frequently in the elderly and in women. Establishing a precise diagnosis of the physiopathology of functional chronic constipation is complex and requires many functional tests in refractory cases. An understanding of intestinal motility and the defecatory process is critical for the appropriate management of chronic functional in...
Chronic constipation: New diagnostic and treatment approaches
2012
Chronic constipation is a highly prevalent disorder that affects approximately 15% of the US population. Chronic constipation refers to patients who have had symptoms for more than 6 months. In clinical practice, chronic constipation is often used interchangeably with the term functional constipation. This is best defined using the Rome III criteria, which involves an evaluation of stool frequency in addition to symptoms of straining, feelings of incomplete evacuation, and the need to use manual maneuvers to assist with stool evacuation. Symptoms can be burdensome, leading to a reduction in patients' quality of life. As a national healthcare issue, chronic constipation is also important because it imposes a significant economic impact on the healthcare system. A number of treatment options are currently available, both over-the-counter and by prescription, although not all patients respond to these therapies. This review will focus on new medical treatment options for the management of chronic constipation, and the safety and efficacy of these agents will be reviewed. In addition, the efficacy of new diagnostic tests to evaluate colonic motility and anorectal function are described.
Clinical and Experimental Gastroenterology, 2021
Chronic idiopathic constipation (CIC) is a common functional bowel disorder characterized by difficult, infrequent, and/or incomplete defecation. It has a great impact on the quality of life and on health care system and represents a heavy economic burden. The diagnosis is based on symptoms, classified by the Rome IV criteria. The aim of this review was to evaluate the current therapeutic guidelines for adult CIC and highlight new emerging treatments. In detail, European, French, Spanish and Korean guidelines have been identified and compared. Osmotic laxatives, and in particular polyethylene glycol, represent the firstline therapeutic approach. Stimulant laxatives are recommended as a second-line therapy. Pelvic floor rehabilitation is recommended in patients with ano-rectal dyssynergia. In patients who fail to improve with pharmacological therapies sacral nerve stimulation is considered as last chance before surgery. Surgical approach has however limited indications in selected cases. Inertia coli refractory to any approach and obstructed defecation are two subtypes which can benefit from surgery. Among emerging agents, prucalopride, a prokinetic agent, is recommended as a second-line treatment in refractory CIC patients. In addition, the secretagogues linaclotide and plecanatide and the bile acid transported inhibitor elobixibat can be effective in patients not responsive to a second-line therapeutic regimen, although they are not worldwide commercially available.
New Treatments for an Old Problem: Chronic Constipation
2006
Commonly used first-line treatments for chronic constipation are simple: dietary fiber, fluids, exercise, and allocating time for defecation. Often, the patient will most likely have tried the first 3 treatments on their own. It is important to document what has been tried and the results. This article describes the recommended treatments for chronic constipation once the patient presents to a healthcare provider for this problem. Frequently recommended treatments include medicinal fiber supplements, bulking agents, stool softeners, and laxatives. Two prescription treatments, tegaserod and lubiprostone, are available. Study results have proven that these treatments have shown good efficacy and tolerability. A brief review of those study results is included in this article, in addition to a discussion of when to refer a patient to the gastroenterologist and the management of pelvic dyssynergia.
Chronic constipation: new insights, better outcomes?
The Lancet Gastroenterology & Hepatology, 2019
Constipation is a symptom that affects around 11-20% of the adult population yearly. Most physicians consider infrequency of defecation as a hallmark of constipation. However, most patients view excessive straining as the biggest component of constipation and only a minority of patients with constipation have infrequent bowel movements. Constipation might be due to many different medical conditions or occur as a side-effect of drug therapy. When these medical conditions or drug therapies are not present, a diagnosis of functional constipation, chronic idiopathic constipation, or irritable bowel syndrome with constipation is often made. In all patients with constipation, rectal outlet dysfunction should be excluded by physical examination because this condition occurs in approximately 25% of patients diagnosed with idiopathic constipation and can be improved with different therapeutic approaches than administration of laxatives. Because of the availability of over-the-counter laxatives, most patients consider themselves able to self-manage constipation, and patients have often tried many different treatments before seeking professional help. The physician must carefully assess these previous efforts of self-treatment, optimise them, and strategically use the increasing list of prescription medications for management.
Recent advances in the management of difficult constipation
2012
Constipation is a highly prevalent disorder. Some patients suffer from acute, intermittent episodes of constipation. Others, however, suffer from chronic constipation, a term that refers to those patients with symptoms of constipation for more than 6 months. In clinical practice, chronic constipation is often used interchangeably with the term functional constipation, which is currently defined using the Rome III criteria. Symptoms can be burdensome, leading to a reduction in patients' quality of life. In addition, chronic constipation is important because it imposes a significant economic impact to the health care system. Some patients with chronic constipation have persistent symptoms despite implementing lifestyle changes and using either over-the-counter agents or prescription medications. These patients may be categorized as having difficult constipation. This report will focus on recent advances in the management of difficult constipation, and include a discussion of new and upcoming medications as well as new diagnostic tests and procedures.