Chronic Constipation – What Works

John Johnson from the University Of Illinois College Of Medicine is a constipation expert. He has recently reviewed what works and what doesn’t. We’ll omit the ‘what doesn’t’. An important factor of any treatment program is to improve the symptoms that are bothering the patient – and these vary, according to the patient’s understanding of the term constipation.

First recommendation: lifestyle measures, such as hydration (adequate fluid intake), increased fiber intake, exercise, and a dedicated time for the bowel movement. (Note that there are no good studies that show that hydration or exercise improve chronic constipation; however, they increase frequency and softness of stools in people without constipation.)

If necessary, the next steps: fiber supplements (e.g. Metamucil®), followed by laxatives, stool softeners, and enemas.

The American College of Gastroenterology has recommended three laxative classes: psyllium to increase frequency; stool softeners, and polyethylene glycol and lactulose for improving frequency and consistency. In general, the effectiveness of laxatives in chronic constipation is disappointing.

Newer drugs – tegaserod (Zelnorm®) and lubiprostone (Amitiza®) – are approved by the FDA for treating chronic constipation, but work is still required to determine how effective they are in the long-term, and whether there are rare but serious side effects.

Finally, neurotrophin-3 is a drug given by subcutaneous injection three times a week. After 8 weeks, it produces an increase in bowel movement frequency, softening of stool, shortened colonic transport time, and improved constipation symptoms. It works, apparently, by re-growth of the nerves supplying the intestines, so that it may offer the hope of a real ‘cure’. We’ll see.