Review of the treatment options for chronic constipation

Abstract

Constipation is a common gastrointestinal motility disorder that is often chronic, negatively affects patients' daily lives, and is associated with high healthcare costs. There is a considerable range of treatment modalities available for patients with constipation; however, the clinical evidence supporting their use varies widely. Nonpharmacologic modalities, such as increased exercise or fluid intake and bowel habit training, are generally recommended as first-line approaches, but data on the effectiveness of these measures are limited. The clinical benefits of various traditional pharmacologic agents (many of which are available over the counter, such as laxatives and fiber supplements) remain unclear. Although these modalities may benefit some patients with temporary constipation, their efficacy in patients for whom constipation is chronic is less well defined. Some studies suggest benefit with psyllium, polyethylene glycol, and lactulose; however, the use of other agents, such as calcium polycarbophil, methylcellulose, bran, magnesium hydroxide, and stimulant laxatives, is not supported by strong clinical evidence. More recently, newer agents have been approved for the treatment of patients with chronic constipation on the basis of comprehensive clinical investigation programs. Tegaserod, with its well-established clinical profile, and lubiprostone, the latest addition to the treatment armamentarium, represent the new generation of therapies for chronic constipation. This article reviews the efficacy and safety of traditional therapies used in the management of the multiple symptoms associated with chronic constipation and discusses recently approved and emerging therapies for this disorder.

Figure 1

Diagnostic/treatment algorithm for constipation. CBC = complete blood count; GI = gastrointestinal; IBD = inflammatory bowel disease; IBS = irritable bowel syndrome; TSH = thyroid-stimulating hormone. Modified from Hunt R, Lacy B. Diagnosis and management of chronic constipation in the primary care setting. Intern Med World Rep. 2004;1(suppl):3-23 with permission from Ascend Media Healthcare.

Figure 2

Tegaserod (6 mg BID) responders for increased complete spontaneous bowel movements (CSBMs). Percentage of patients experiencing an increase of 1 or more CSBMs per week during weeks 1-4 (primary efficacy variable). BID = twice daily