Chronic Constipation: Gastroenterology Guidelines Propose 2 Fresh Treatments.

The American Gastroenterological Association (AGA) and the American College of Gastroenterology (ACG) have recently released new guidelines for treating chronic idiopathic constipation in adults, which includes 10 evidence-based ways to treat the condition, with two of them being introduced for the first time. These updated recommendations now include magnesium oxide and senna as potential treatment options for chronic constipation, in addition to eight other options.

One of the authors of the recommendations, Lin Chang, MD, AGAF, FACG, states that “Randomized, placebo-controlled clinical trials were evaluated using GRADE methodology [Grading of Recommendations Assessment, Development, and Evaluations] and certainty of the evidence was rated and recommendations made regarding the use of these treatments.” This expansion of treatment options can make the process of treating CIC more manageable for physicians, as this condition affects between 8% and 12% of people in the U.S., with symptoms that include infrequent, incomplete, and difficult-to-pass bowel movements.

William D. Chey, MD, AGAF, FACG, who is an author of the updated guidelines, notes that magnesium oxide, which can be purchased at a local grocery store or pharmacy, can be very safe and beneficial to patients with chronic constipation, as it causes a release of the body’s own fluid into the bowel lumen, which softens the stool and can stimulate the bowel indirectly to contract, which helps pass stool through the GI tract. Studies from Japan have also supported the benefits of magnesium oxide for chronic constipation, with Dr. Chey recommending starting at 400 mg to 500 mg per day and increasing the dosage to no more than 1,500 mg per day, as needed.

Senna, which is derived from the Senna alexandrina herb, has been used for centuries to treat chronic constipation and stimulates the colon to contract, which helps relieve constipation. However, it can cause cramping at higher doses, so it is recommended to use it intermittently when feeling more constipated, as opposed to everyday use. Dr. Chey notes that one trial from Japan has shown that senna and magnesium oxide are similarly effective in treating chronic constipation.

The guidelines also include non-pharmacological options for treating chronic constipation, including the use of osmotic laxatives, stimulant laxatives, guanylate cyclase-C agonists, and 5HT4 agonists, as well as suggesting the use of fiber, magnesium oxide and lactulose, senna, and ClC-2 activators. Other factors such as shared decision-making between the provider and patient, patient preferences, medication costs, and availability are also taken into consideration when determining the best course of treatment.

According to Trish Gomez, RD, CPT, a registered dietitian with Vanderbilt Stallworth Rehabilitation Hospital, there are several things people can do to treat chronic constipation. However, it is important to seek medical attention if ongoing constipation persists despite these efforts.

“Many non-gastrointestinal conditions such as hypothyroidism can be a cause of constipation,” Dr. Pimentel explained. “In addition, medications are a common cause. For example, commonly used anti-depressants can cause constipation.”

Likewise, if your constipation is a new symptom for you, this also could be a reason to be evaluated as well, he added. “If you are over the age of 45 years of age, new onset constipation could be a symptom of colon cancer. Be sure you are up to date on colonoscopy for cancer screening.”

He noted that other important red flags to alert a healthcare provider about are blood in the stool, unexpected weight loss, and a family history of colon cancer.