Medications to treat constipation include bulk-forming agents (fibers), emollient stool softeners, rapidly acting lubricants, prokinetics, laxatives, osmotic agents, and prosecretory drugs. Fiber is arguably the best and least expensive medication for long-term treatment, although enthusiasm for the use of polyethylene glycol as first-line therapy in chronic constipation is increasing.
NOTE: In January 2014, the FDA issued a warning that exceeding 1 dose of OTC sodium phosphate products for constipation over a course of 24 hours may cause serious harm to the kidneys and heart and, in rare cases, may be fatal. [ 18 , 19 ] Using more than the recommended dose of these products can cause severe dehydration and changes in serum electrolyte levels. Individuals who may be at higher risk for potential adverse events include young children; patients older than 55 years; patients who are dehydrated; patients with kidney disease, bowel obstruction, or inflammation of the bowel; and patients who are using medications that may affect kidney function. [ 18 , 19 ]
Emollient stool softeners are easier to use, but they lose their effectiveness with chronic administration. These drugs are best used for prophylaxis in a short-term setting, such as in patients receiving a postoperative narcotic prescription.
Rapidly acting lubricants and laxatives, including over-the-counter products, are often used to treat acute and chronic constipation.
Polyethylene glycol is simple to use and is more effective than placebo in the management of chronic constipation; however, the effects of chronic therapy with polyethylene glycol over decades are still not well studied.
Newer therapies for constipation include the prokinetic agent prucalopride (not approved in the United States), the osmotic agent lubiprostone, and the guanylate cyclase C (GC-C) agonists, linaclotide and plecanatide.
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Large amount of stool throughout colon.
Large stool mass in hepatic flexure of colon.
Colon distention secondary to fecal impaction.
Pseudo-obstruction secondary to fecal impaction.
Distended transverse colon.