Article Figures & Data
Figures
- Figure 1.
Flow diagram for management of chronic constipation.
Tables
- Table 1.
Summary of Various Management Options for Chronic Constipation According to the Strength of Recommendations Taxonomy (SORT)81
Treatment Level of Recommendation Comments Reference Nonpharmacological Increasing dietary fiber C No RCTs, data from multiple observational studies, results conflicting. More likely to be beneficial in people with fibers deficiency. 34,82–87 Increasing exercise B Two small RCTs with opposite results and 2 other cohorts showing benefits. More likely to be beneficial in people with lack of exercise. 9,83,88,89 Increasing fluids C One observational study and 1 controlled trial, the latter showing benefits of increased fluids only in presence of sufficient fiber intake. 90,91 Biofeedback B Useful in pelvic function disorder type of chronic constipation. Benefits reported with both uncontrolled trials and RCTs. However, protocols of biofeedback vary and are heterogeneous in nature; hence recommendation is not standardized. 46,92–94 Bacteriotherapy (probiotics) C One prospective study of bifidobacterium and one uncontrolled trial of Lactobacillus; viability of preparation when consumed is questionable. 95–97 Surgery (colectomy/hemicolectomy) B One systematic review reported benefits based on case reports and no RCT; quality of studies was heterogeneous. 139 Surgery (partial division of puborectalis) B Two RCTs randomizing patients to surgical and nonsurgical treatments (biofeedback or Botulinum toxin injection). 140,141 Pharmacological Psyllium A At least 3 well-designed RCTs showing benefits over placebo. 98–101 Bran B Two controlled trials showed benefits in reducing use of laxatives. 102,103 Methylcellulose B Only 1 controlled trial of medium quality. 104 Polycarbophil B Only 1 case series of medium quality. 105 Polyethylene glycol A At least 3 RCTs showing benefits over placebo. 106–108 Lactulose A Two systematic reviews of RCTs with benefits over placebos. 109,110 Sorbitol B One double-blind RCT showing comparable efficacy of sorbitol with lactulose, not placebo. 111 Magnesium hydroxide (milk of magnesia) C No evidence of benefits from any studies, with 1 adverse report of overuse. 112 Senna A At least 3 controlled trials showing benefits over placebo. 115–117 Docusate sodium B One double-blind RCT comparing with psyllium. 98 Bisacodyl A One double-blind RCT with 1 open-labelled controlled trial. 113,114 Lubiprostone A At least 3 double-blind RCTs showing benefits over placebo. 118–120 Tegaserod – At least 3 RCTs from different centers showed benefits over placebo. Withdrawn from market by FDA because of concern; 2 recent cohorts claim no association with cardiovascular risks. 121–129 Prucalopride A At least 3 RCTs showing benefits over placebo, including severe chronic constipation. At present only marketed in Europe. 130–135 Traditional Chinese medicine B Two RCTs showing benefits of a particular formula, yet overall quality of studies are heterogeneous. 136–138 RCT indicates randomized, controlled trial; FDA, Food and Drug Administration.
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