Chronic constipation: Update on management

Umar Hayat; Mohannad Dugum; Samita Garg

doi:10.3949/ccjm.84a.15141

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FIGURE 1
Diagnosis and management of chronic constipation.

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TABLE 1

Causes of secondary constipation

Neurologic and motility disorders
Amyloidosis
Diabetes
Hirschsprung disease
Hypothyroidism
Multiple sclerosis
Parkinson disease
Spinal cord injury
Spinal or ganglionic tumors
Stroke

Diseases in which treatment can cause constipation
Bipolar disorder
Chronic pain
Depression
Parkinson disease
Schizophrenia

Medications
Anticholinergics
Anticonvulsants
Antidepressants
Antipsychotics
Antispasmodics
Calcium channel blockers
Opioids

Other causes
Chagas disease
Conversion disorder
Decreased fluid intake
Hypercalcemia
Hyperparathyroidism
Low-fiber diet
Mechanical obstruction

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TABLE 2

Nonpharmacologic management of chronic constipation

Increase physical activity (most beneficial in early orning)

Toilet training. Instruct patients to:
Not ignore urges to defecate
Use correct posture, ie, “brace-pump” technique: sit on the toilet and lean forward, with knees higher than hips and with feet supported on a step to straighten the anorectal angle
Do deep-relaxation techniques while defecating
Avoid straining when passing stool
Not stay on the toilet for more than 5–10 minutes

Dietary changes
Drink a hot caffeinated beverage after waking up
Eat breakfast within 1 hour of waking up
Increase fluid intake to 1.5–2 L daily
Increase dietary fiber to 25–30 g daily; do this slowly to avoid abdominal cramps and bloating