An overview of interventions for constipation in adults

ABSTRACT

Introduction

The increasing global prevalence of the symptoms of constipation adversely affects the quality of life (QOL) of symptomatic patients. An acceptable universal definition of constipation does not exist and a detailed history taking form each patient with various complaints including stool consistency, sensing of incomplete evacuation or a manual need to assist evacuation is required. Complexity of obtaining etiologic diagnosis and the wide range of therapeutic options can mislead physicians in choosing correct treatment.

Areas covered

This review, considers the pathophysiology of constipation and the diagnostic approach to identify the etiology of constipation. Available interventions including non-pharmacological, pharmacological, and invasive methods such as acupuncture and surgical management are discussed. This review utilized on PubMed, Google Scholar, Scopus, and clinicaltrials.gov to search for studies and reviews published between 2000 and 2020.

Expert commentary

Constipation necessitates careful considerations to detect the exact pathophysiology. Medical history, focused physical assessments, and selected diagnostic tests help choosing the right management. Non-pharmacological methods are beneficial in most of the cases. If a satisfactory response is not achieved, over the counter or prescribed medications are available. Options for patients who failed to respond to available medications are addressed in this review.

KEYWORDS:

• Constipation
• management
• pharmacological
• nonpharmacological
• expert commentary
• cost

Article highlights

• Constipation is a global concern, associated with inevitable impacts on the QOL of the patient and can be arisen from different secondary causes such as neurological disorders, metabolic diseases, medications, etc.

• In secondary-cause constipation, management of the disorder (e.g., Parkinson’s disease), replacing the medication (e.g., altering anticholinergics) or consumption of relevant antagonists (e.g., PAMORAs for OIC) have priority in the management process.

• Nonpharmacological management of constipation is counted as the first step in the therapy, which consists of diet and lifestyle modifications. High fiber diets, increase of fluid intake, response to the urge of defecation, probiotics, and biofeedback training are generally recommended.

• Laxatives are indicated as primary pharmacological management, which is divided into bulk-forming, stimulants, and osmotic subgroups.

• GCC receptor agonists, lubiprostone, and prucalopride are the most commonly prescribed medications for constipation, which are associated with many health benefits with less adverse effects. These medications should be individualized based on the patient’s history, medication, comorbidities, etc.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Additional information

Funding

This paper was not funded.