What is the medical treatment of chronic constipation?

Start with reassurance, lifestyle change (increased fibre and fluids), and toilet training. Laxatives are used by class - bulk-forming, osmotic (non-absorbable sugars, magnesium salts), and stimulant (anthranoid) agents - plus prokinetics (e.g. prucalopride) and enemas/suppositories.

Clinical relevance. A stepwise approach of lifestyle measures then laxative classes manages most chronic constipation.

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Medical treatment of chronic constipation

Most patients need only reassurance and lifestyle measures, with laxatives added in a stepwise manner.

First-line

• Reassurance, lifestyle change, and attention to psychosocial factors.
• Increase dietary fibre and fluid intake (first-line for mild constipation; takes several weeks).
• Toilet training/routine.

Laxative classes

• Bulk-forming (purgatives/fibre).
• Osmotic: non-absorbable sugars (e.g. lactulose), magnesium salts.
• Stimulant (anthranoid compounds) - avoid laxative abuse/dependence.

Other agents and routes

• Prokinetic agents (e.g. prucalopride, a 5-HT4 agonist).
• Enemas and suppositories for evacuation.