New Treatments for an Old Problem: Chronic Constipation*

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. (Adv Stud Med. 2006;6(10B):S962-S967) Patients suffering from chronic constipation a re often willing to try almost anything to re l i e ve their pain and discomfort. Howe ve r, first-line treatments for constipation are, in fact, simple: increased dietary fiber, fluids, e xe rcise, and allocating time to have a bowel movement. The patient will most likely have tried the first 3 t reatments on their own. As Julia Pallentino, MSN, JD, ARNP-BC, notes in this monograph, it is important to document what has been tried and the results. On the other hand, allocating sufficient time for a bowel movement is often not considered, but is a common re m e d y for chronic constipation. The best time for a bowe l m ovement is in the morning, after breakfast, when d i g e s t i ve stimuli prompt the urge to evacuate the bowels. If that urge is ignored, it tends to diminish ove r time. Scientific evidence showing that these simple t reatments (other than increased dietary fiber) are effect i ve is lacking, but this has not diminished their popularity or usefulness. Fiber consists of the long-chain polysaccharides and several other plant components, such as cellulose, lignin, and waxes, which are not digested in the human stomach or small intestine. If the patient is not consuming sufficient fiber (>20 g daily), he should begin with lower doses (4–6 g daily) of dietary fiber (eg, bran), or medicinal fiber (eg, psyllium), and increase it gradually to avoid bloating and flatulence. The digestive tract needs time to adjust to the increase in fiber intake. There are many types of medicinal fiber supplements available: psyllium, methylcellulose, calcium polycarbophil, and guar gum. The total recommended daily intake of fiber (diet + supplementation) is 20 to 25 grams, but could be increased to 30 grams, if necessary. Several Web sites provide the fiber content for different foods (Table 1); this information is also available on the nutrition labeling of products. Bulking agents are poorly absorbed agents that act PROCEEDINGS