The treatment of functional constipation in adults depends on eliminating the underlying cause and distinguishing between different subtypes of functional constipation, such as normal transit, slow transit, or an evacuation disorder, which has substantial therapeutic implications. Adult functional constipation is treated with a combination of lifestyle modifications, pelvic floor therapies (if a rectal evacuation disorder exists), and pharmacological treatment.1
| Nonpharmacologic treatment | |||
| Lifestyle modifications | toileting after meals, increased fluid intake, increased dietary fibre intake, and increased physical activity | ||
| Biofeedback | Effective for treating constipation caused by pelvic floor dysfunction. | ||
| Pharmacological treatments | |||
| Drug | Dosages | Time of onset | Side effects |
| Bulking agents | |||
| Methylcellulose powder | 19 g/day | 12 to 72 hours | – |
| Polycarbophil tablets | 1,250 mg/day, (one to four times) | 12 to 72 hours | – |
| Psyllium powder | 1 tsp/day or 1 packet/day (one to three times) | 12 to 24 hours | Bloating, abdominal distension |
| Osmotic laxatives | |||
| Lactulose solution | 15 to 30 mL/day | 24 to 48 hours | Bloating and cramping, nausea |
| Magnesium citrate solution | 150 to 300 mL, single dose or short-term daily dose | 30 minutes to 6 hours | Increase in magnesium, causing lethargy, hypotension, respiratory depression |
| Magnesium hydroxide suspension | 30 to 60 mL/day | 30 minutes to 6 hours | Increase in magnesium, causing lethargy, hypotension, respiratory depression |
| Polyethylene glycol powder | 17 g/day | 24 to 48 hours | Minimal adverse effects of cramping and gas |
| Sorbitol solution | 2 to 3 tbsp, single dose or short-term daily dose | 24 to 48 hours | Bloating, cramping, and nausea |
| Stool softeners | |||
| Docusate sodium capsules | 100 mg twice/day | 24 to 48 hours | – |
| Stimulant laxatives | |||
| Bisacodyl tablets | 5 to 15 mg/day | 6 to 10 hours | Diarrhoea and abdominal pain in 56% in week 1 and 5% in week 4 |
| Senna tablets | 15 mg/day | 6 to 12 hours | Abdominal pain in up to 12% |
| Chloride channel activators | |||
| Lubiprostone capsules | 24 mcg twice/day | Within 24 hours | Nausea |
| Peripherally acting mu-opioid antagonists | |||
| Methylnaltrexone solution | Weight-based subcutaneous injection, once or twice/day | 30 to 60 minutes | Diarrhoea, abdominal pain |
| Other | |||
| Linaclotide capsules | 145 mcg/day | Diarrhoea leads to treatment cessation |
Surgery is a last-resort treatment. There are no clear standards on how to manage functional constipation surgically, and techniques differ greatly between children and adults.[1]
Citation
- ^ Vriesman MH, Koppen IJN, Camilleri M et al. Management of functional constipation in children and adults. Nat Rev Gasteroenterol Hepatol. 2020;17:21-39.https://www.nature.com/articles/s41575-019-0222-y
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