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Constipation Therapy – Treatment and Relief

Constipation therapy includes all measures used to treat constipation, ranging from dietary changes and physical activity to laxative medications.

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Things worth knowing about "Constipation Therapy"

Constipation therapy includes all measures used to treat constipation, ranging from dietary changes and physical activity to laxative medications.

What Is Constipation Therapy?

Constipation therapy refers to the targeted treatment of constipation – a condition characterized by fewer than three bowel movements per week, hard or lumpy stools, or difficulty and straining during defecation. The goal of treatment is to restore normal bowel function, relieve discomfort, and improve the quality of life for those affected. Treatment is always tailored to the underlying cause and the severity of the condition.

Causes of Constipation

Identifying the cause of constipation is essential before starting any therapy. Common causes include:

Low-fiber diet and insufficient fluid intake
Physical inactivity and a sedentary lifestyle
Medication side effects (e.g., opioids, antidepressants, iron supplements)
Hormonal disorders such as hypothyroidism or diabetes mellitus
Neurological conditions such as Parkinson's disease or multiple sclerosis
Irritable bowel syndrome (constipation-predominant subtype)
Structural bowel disorders or psychological factors such as stress and anxiety

General Measures and Basic Therapy

The foundation of constipation therapy consists of non-pharmacological measures, which are often sufficient on their own:

Dietary changes: Increasing fiber intake to 25–30 g per day through whole grains, vegetables, legumes, and fruit
Adequate fluid intake: At least 1.5–2 liters of water or unsweetened beverages daily
Regular physical activity: Exercise promotes intestinal motility and can increase stool frequency
Bowel habit training: Establishing regular toilet times, especially after breakfast, takes advantage of the natural gastrocolic reflex
Stress reduction: Relaxation techniques can help in cases of psychologically triggered constipation

Pharmacological Therapy

When general measures are insufficient, various laxatives are available. The choice of laxative depends on the mechanism of action and the individual needs of the patient.

Osmotic Laxatives

These agents retain water in the intestine, softening the stool. Commonly used substances include macrogol (polyethylene glycol) and lactulose. Macrogol is well tolerated and is often recommended as a first-line treatment.

Stimulant Laxatives

Bisacodyl and sodium picosulfate stimulate the intestinal muscles to contract, speeding up stool transit. They act quickly but should not be used long-term without medical supervision.

Bulk-Forming Agents

Psyllium husk and wheat bran increase stool volume and stimulate bowel movement. Adequate fluid intake is essential when using these agents.

Lubricant Laxatives

Liquid paraffin and glycerin suppositories ease the passage of stool through lubrication. Suppositories act locally and can be useful for acute constipation.

Prokinetics and Newer Agents

For severe chronic constipation that does not respond to standard laxatives, more targeted agents may be used, including prucalopride (a serotonin receptor agonist that enhances intestinal motility) or linaclotide (for irritable bowel syndrome with constipation).

Treatment of Specific Causes

When constipation is caused by medication (e.g., opioids), the causative drug should be adjusted where possible or supplemented with specifically effective laxatives. For hormonal or neurological underlying conditions, treating the root cause takes priority. In rare cases involving structural bowel disorders, surgical intervention may be necessary.

Therapy in Children

In children, the primary approach also involves dietary adjustments and adequate fluid intake. Macrogol is approved for use in children and is considered a safe first-line treatment. Enemas or other invasive measures are only used when other therapies have not been effective.

When to See a Doctor

Medical evaluation is recommended in the following situations:

Newly occurring constipation without an obvious trigger
Blood in the stool or severe abdominal pain
Unintentional weight loss
Constipation lasting more than 3 weeks
Suspected underlying medical condition

References

Bharucha A.E. et al.: American Gastroenterological Association Technical Review on Constipation. Gastroenterology, 2013;144(1):218–238.
Muller-Lissner S. et al.: Myths and misconceptions about chronic constipation. American Journal of Gastroenterology, 2005;100(1):232–242.
World Gastroenterology Organisation (WGO): Global Guidelines on Constipation, 2010. Available at: https://www.worldgastroenterology.org

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