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