by Eileen Schweickert

Created on: December 09, 2008

There is nothing funny about chronic constipation, though the subject is frequently used by comedians as the focus for jokes. Just as frequently, patients approach their health care providers for help with this uncomfortable issue. In adults there are two types of chronic idiopathic constipation. This means constipation not associated with any underlying medical condition or anatomic problem with the elimination tract. First is the more common difficulty defecating with normal bowel transit. This means there is difficulty or discomfort passing stool, but bowel movements happen regularly. Less common is constipation due to transit abnormality which results in less frequent bowel movements. In this case, fecal material takes longer to pass through the gut tube and bowel movements are less frequent. Both types of constipation are usually treated in a similar fashion.

The incidence of constipation increases with age. In the general population it is estimated that about 20% of the eldery suffer from chronic constipation. It is probable that constipation is a risk factor for hemorrhoids, fecal impaction, and diverticular disease. Diverticular disease occurs when pressure within the gasterointestinal tract causes pockets to form in the wall of the gut lining. Material can become caught in these pockets resulting in inflammation and sometimes perforation.

Chronic constipation is believed to be caused by low fiber diet, immobility, decreased fluid intake, and is commonly a side effect of medications. It would make sense then that treatment for this condition would focus on correcting these risk factors. And this is in fact what studies do show to be useful.

Most effective is the arena of non drug therapies for chronic constipation is increasing both fiber in the diet, and physical exercise. Both of these measures have been shown in studies to be effective in improving frequency of bowel movements and making bowel movements easier. There is some evidence also to support increasing fluid intake as a adjunct to the increase in dietary fiber. Biofeedback has been shown to be useful in treatment of constipation when it is due to abnormal transit time.

There are several types of laxatives commonly prescribed for constipation but not all of them have been well studied. The most evidence exists supporting the use of macrogol laxatives. These are laxatives made from polyethelylene glycol. These laxatives have not been linked to any serious adverse effects.

Laxatives made from psyllium husks appear to be more effective than those made from lacitol or lactulose though these may be helpful in increasing the frequency of bowel movements.

There is no good data to support the use of stimulant laxatives, other osmotics like magnesium salts, other bulk forming laxatives aside from psyllium husk, or the use of paraffin or seed oils. These forms of laxatives have not been studied adequately in order to determine their effectiveness.

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