Optimal treatment of chronic constipation in managed care: review and roundtable discussion.

BACKGROUND Prevalence studies estimate that chronic constipation affects 12%-19% of Americans. This prevalence rate exceeds that of many highly publicized chronic conditions, including diabetes and asthma. Identifying the etiology of each patient's constipation is essential for determining treatment and management plans. The etiology of chronic constipation falls into 2 broad categories: primary or idiopathic constipation caused by physical and functional problems, and secondary constipation resulting from a variety of organic conditions as well as the use of certain medications. Patients may have more than one cause of their constipation. Treatment options may be based not only on the cause but may be dictated by a patient's health care coverage and the inclusion criteria of different health care plans. OBJECTIVES To (a) present key information on the causes, diagnosis, and treatment recommendations for patients with chronic constipation; (b) describe how chronic constipation impacts quality of life; and (c) describe how all providers can work to improve the quality of care and health outcomes for patients with chronic constipation. SUMMARY Chronic constipation is a prevalent condition that disproportionately affects women and the elderly. Most agents are available over-the-counter, although their efficacy has not been extensively tested. Few prescription agents are currently available, and they are more costly; therefore, managed care plans may restrict these products for patients who fail traditional treatments. A lack of evidence-based algorithms leaves many providers to treat patients empirically. Practitioners can assist patients seeking recommendations and provide information on treatment options.