A new practice guideline aims to help clinicians navigate an increasingly crowded field of over-the-counter and prescription treatment options for chronic idiopathic constipation in otherwise-healthy people., was developed jointly by the American Gastroenterological Association and American College of Gastroenterology. It marks the AGA's first update on chronic idiopathic constipation , also called functional constipation, in a decade.
One commonly used agent in clinical practice, the stool softener docusate sodium, does not appear in the guideline, as there was too little data available on it to make an assessment, Chang said. Fruit-based laxatives were excluded because they were the subject of a recent evidence review. Lifestyle modifications such as exercise, surgical interventions, and probiotics were not assessed.
In general,"if someone has more mild symptoms, you should try fiber or increase their fiber intake in their diet," Chang commented."If that doesn't work, try over-the-counter remedies like polyethylene glycol. Then if symptoms are more severe, or if they fail the first-line treatments, then you go to prescription agents."
Chang said that, while the new guideline covers medication options for otherwise-healthy adults, clinicians should be mindful that patients presenting with CIC might still have a defecatory disorder."A person could also have pelvic floor dysfunction as a primary cause or contributing factor. If someone fails fiber or polyethylene glycol, consider a digital rectal examination as part of the physical exam. If this is abnormal, consider referring them for anorectal manometry.