Common Treatments

Mild cases of constipation can be easily treated with fiber-rich foods like fruits, vegetables, whole grains etc. Though in uncured condition patients adhere to supplements and drugs to aid bowel regularity.

How to treat chronic constipation?

Most often the acute constipation is successfully treated by our bodies own self-healing capability. But in some cases, it may develop into a chronic condition where it only can be treated by medication. Most of the practitioners prescribe laxatives and steroid containing ointment for treating constipation and its associated problems. But taking medication have a lot of side effects and discomfort to the patients.

Commonly used over the counter (OTC) preparations for chronic constipation:


1. Lubricant laxative - Mineral oil (Lubricant Petrolatum)

Mechanism of action:
This lubricant laxative coat the bowel with a waterproof film to avoid the absorption of water from the stool. Thus it encourages the bowel movement easier.

Caution and side effects:
Children’s below 6 years should not be treated with mineral oil for treating constipation. Per day only one mineral oil enema should be taken. Need to consult a physician if rectal bleeding or not having a bowel movement after using the mineral oil preparation. Mineral oil causes pneumonia if it leaks into the lungs. Sometimes it leaks into rectum when it taken in higher doses. This leads to itching around the anus. Should not be used during pregnancy or when planning for pregnancy since it inhibits vitamin absorption. Side effects of mineral oil are mild bloating, gas, diarrhea and stomach cramps

2. Emollient laxative - Docusate Calcium or Sodium (Anionic Surfactant)

Mechanism of action:
These are also called stool softeners which helps by reducing the surface tensions by allowing water and lipids to penetrate the stools. Thereby preventing the dry and hard stools. It only helps the patient to have a bowel movement without straining.

Caution and side effects:
Irritated throat, severe dizziness, trouble in breathing. The patient needs to discontinue if abdominal pain, GI bleeding, and vomiting occur.

3. Osmotic laxative - Polyethylene Glycol, Magnesium Hydroxide, Lactulose, Sorbitol, Magnesium Citrate

Mechanism of action:
It encourages the bowel movement by engulfing water from surrounding body tissues resulting in distention and promotes peristalsis.

Caution and side effects:
These can cause problems like bloating, diarrhea. Dehydration occurs for some people due to electrolyte imbalance as they draw out of nutrients and other elements along with water.

4. Bulk-forming laxatives - Psyllium, Polycarbophil, Guar Gum, Methylcellulose, Malt Soup Extract

Mechanism of action:
These laxatives are not digested but absorbs the liquids from the intestine and swell to soften the stool. Due to bulky mass bowel is stimulated normally.

Caution and side effects:
Milk stomach pain, bloating, Intestinal blockage, skin rash, itchiness, difficulty swallowing and breathing

5. Stimulant laxatives - Dehydrocholic Acid

Mechanism of action:
It induces the bowel movements by increasing the contraction of muscles in the intestines.

Caution and side effects:
Medication cause urine to turn reddish-brown (harmless effect), nausea, diarrhea, weakness.

Prescription drugs for chronic constipation:

These are RX medicines should be taken only with physician’s advice.

Linaclotide

It is approved by US FDA and it is used to treat Irritable Bowel Syndrome with Constipation (IBS-C) & Chronic Idiopathic Constipation (CIC). Linaclotide is a Guanylate Cyclase-C (G-CC) agonist. Linaclotide is structurally related to human Guanylin and Uroguanylin and functions as a Guanylate Cyclase-C (GC-C) agonist. It is a peptide agonist works by increasing the amount of fluid in the intestine. It increases smooth muscle contraction thereby promoting bowel movement.The most common side effect of Linaclotide is diarrhea, gas, abdominal pain, and flatulence. The US FDA labeled the drug as black box warning to not to use for children’s under 6 years. And also to avoid 6 years to 18 years old due to the risk of serious dehydration.

Source : https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=09beda19-56d6-4a56-afdc-9a77b70b2ef3

Lubiprostone

It is an oral bicyclic fatty acid approved US FDA which is used for treating chronic idiopathic constipation in adults. It is also approved to treat irritable bowel syndrome with constipation for women’s 18 years and older. Lubiprostone is a prostaglandin derivative which activates CIC-2 chloride channels on gastrointestinal epithelial cells which produce chloride-rich fluid secretion. These secretion helping the stool to get soften and also increase the spontaneous bowel movement. The adverse event of the drug includes in the clinical trial study the most adverse effects was nausea and others effects include diarrhea, headache, and abdominal distention.

Source : https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=222817c2-d4a6-43d0-8cbb-215f19acb198

Prucalopride Succinate

Prucalopride succinate is not approved by US FDA, however, this is approved in Europe, Canada, and many other countries. Prucalopride is indicated for symptomatic treatment of chronic constipation in adults in whom laxatives fail to provide adequate relief.Prucalopride is a selective serotonin (5-HT4) receptor agonist, which have prokinetic effects. Prucalopride is a dihydro-benzofuran-carboxamide with gastrointestinal prokinetic activities. Adverse effects of the drug include a Headache, Dizziness, Tremors, Palpitations, Nausea, diarrhea, abdominal pain, Vomiting, dyspepsia, flatulence, gastrointestinal sounds abnormal, Rectal hemorrhage, Pollakiuria, and Fatigue.

Source : https://www.medicines.org.uk/emc/product/584/smpc

Methylnaltrexone

It is US FDA approved narcotic drug act as a µ-opioid antagonist for treating opioid-induced constipation. Generally, it is used when the conventional laxatives failed. Methylnaltrexone acts as an antagonist binds with the same receptor as an opioid analgesic does. This drug does not cross blood brain barrier due to its positive charge in nitrogen atom so that it will reverse the painkilling properties of opioid agonists such as morphine. Common side effects are flatulence, dizziness, hot flashes, tremor, and chills.

Source : https://www.rxlist.com/relistor-side-effects-drug-center.htm

Naloxegol Oxalate

Naloxegol is approved by US FDA as an oral tablet. Naloxegol Oxalate is indicated in for the treatment of opioid-induced constipation (OIC) in adult patients with chronic non-cancer pain. It is a peripherally acting µ opioid antagonist. After administration Naloxegol binds to and blocks µ-receptor in the peripheral nervous system and thus prevents opioid receptor activation and nullify opioid-induced constipation. The side effects of Naloxogol include a tear in the stomach or intestinal wall. Naloxegol is an opioid antagonist and has withdrawal symptoms of opioid which include sweating, chills, diarrhea, stomach pain, anxiety, irritability and yawning.

Source : https://www.accessdata.fda.gov/drugsatfda_docs/label/2014/204760s000lbl.pdf

Plecanatide

Plecanatide is approved by US FDA as an oral tablet. Plecanatide is indicated in adults for the treatment of chronic idiopathic constipation (CIC). Idiopathic means the cause of the constipation is unknown. Plecanatide is structurally related to 16 amino acid named as human Uroguanylin, Plecanatide functions as a Guanylate Cyclase-C (GC-C) agonist. From the literature it is known that Plecanatide shown to increase fluid secretion into the gastrointestinal tract, accelerate intestinal transit and cause changes in stool consistency. Diarrhea is the most common side effect of Plecanatide.

Source : https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/208745lbl.pdf

Colchicine

Colchicine is approved by US-FDA, however not for constipation or other related conditions. From the literature it is known that colchicine is not under the category of laxative but it is used to treats chronic constipation by increasing the more bowel movement. Studies shown that colchicine enhances the spontaneous bowel movements hastens gastrointestinal transit and also improves gastrointestinal symptoms in patients with chronic constipation. Patients with renal insufficiency should not take this drug. Sometimes it causes myopathy.

Source : https://www.ncbi.nlm.nih.gov/pubmed/12809836