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New Approaches to Treating Chronic Constipation

Summary & Participants

Treating constipation starts with lifestyle changes and laxatives. But when they are not enough, a brand new approach that regulates the transmission of nerve signals in the gut might help.

Medically Reviewed On: March 17, 2005

Webcast Transcript

ANNOUNCER: Constipation affects millions of Americans. But they don't all describe it the same way.

LAWRENCE R. SCHILLER, MD: We see that some patients have mainly infrequency, where they go for longer than usual periods of time without having a bowel movement. But, for many patients, it's just problems with the actual process. It's painful, it may be difficult to evacuate the stools, the stools may seem hard or there may be changes in stool form that attract their attention and get labeled as constipation.

ANNOUNCER: Constipation is considered "chronic" when these problems last several months. When a patient sees a doctor about constipation that just won't go away, the doctor's first task is to rule out several possible, potentially serious, causes.

LAWRENCE R. SCHILLER, MD: When we interview a patient, we try to discover whether they might have some underlying health problem. For instance, you could have an obstructing tumor in the rectum that would block the ability to defecate. You could have a problem with your thyroid gland and be hypothyroid and have a problem with constipation. You could have diabetes and have a problem with constipation.

ANNOUNCER: But usually there's no specific cause, and the process of treating constipation can begin. Traditionally, the starting point has been a recommendation for several so-called "lifestyle changes."

JOHN F. JOHANSON, MD: And those things would include drinking more water, trying to exercise more, eating more fiber in your diet, or adding fiber supplements if you're not able to eat enough fiber in your diet. Unfortunately, a lot of times, particularly those with chronic constipation, these interventions don't work very well.

ANNOUNCER: The next step is likely to be a laxative.

LAWRENCE R. SCHILLER, MD: The laxatives that we prefer to treat patients with are what are called osmotic laxatives. These are agents that retain water within the gastrointestinal tract and thereby soften the stools and increase the amount of stool that's formed each day. The most common and readily available of these would be milk of magnesia or similar products.

ANNOUNCER: Other laxatives are bulking agents, usually containing fiber. There are also lubricants, such as mineral oil. Still other laxatives stimulate the colon. Despite the variety, laxatives don't help everybody.

JOHN F. JOHANSON, MD: I think the benefits of a laxative in patients with chronic constipation are variable based on the individual patient. Some people will get some benefit from the laxative, but have side effects and so they won't feel any better. Other people won't get any benefit from the laxative for their constipation.

ANNOUNCER: When laxatives are not effective, there's a new option. But first, some background about the digestive system.

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