Constipation is a widespread condition that impacts quality of life1

42 million people suffer from the
discomfort of constipation each year2

 

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Female patients are more likely than males
to experience constipation3

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Hormones, diet, supplemental iron, pregnancy, and menopause are all factors that may lead to constipation in women.4-8

Constipation symptoms can interrupt patients’ daily lives1

~70% of people had difficulty working, and at least 1 in 10 people missed work or school completely due to chronic constipation.

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Unresolved constipation can lead to long-term consequences9

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Untreated constipation can lead to more serious health problems such as hemorrhoids, anal fissures, rectal prolapse, or fecal impaction.

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    References: 1. Johanson JF, Kralstein J. Chronic constipation: a survey of the patient perspective. Aliment Pharmacol Ther. 2007;25:599-608. doi:10.1111/j.1365-2036.2006.03238.x 2. NIH. National Institute of Diabetes and Digestive and Kidney Diseases. Definitions & facts for constipation. Accessed September 17, 2021. https://www.niddk.nih.gov/health-information/digestive-diseases/constipation/definition-facts 3. McCrea GL, Miaskowski C, Stotts NA, Macera L, Varma MG. A review of the literature on gender and age differences in the prevalence and characteristics of constipation in North America. J Pain Symptom Manage. 2009;37(4):737-745. doi:10.1016/ j.jpainsymman.2008.04.016 4. Vlitos A, Davies GJ. Bowel function, food intake and the menstrual cycle. 1996;9(1):111-134. doi:10.1079/NRR19960008 5. NIH. Office of Dietary Supplements. Iron. Fact sheet for health professionals. Accessed September 17, 2021. https://ods.od.nih.gov/factsheets/iron-HealthProfessional/ 6. Bradley CS, Kennedy CM, Turcea AM, Rao SSC, Nygaard IE. Constipation in pregnancy: prevalence, symptoms, and risk factors. Obstet Gynecol. 2007;110(6):1351-1357. doi: 10.1097/01.AOG.0000295723.94624.b1 7. Gjerdingen DK, Froberg DG, Chaloner KM,McGovern PM. Changes in women’s physical health during the first postpartum year. Arch Fam Med. 1993;2(3):277-283. doi:10.1001/archfami.2.3.277 8. Oliveira SC, Pinto-Neto AM, Conde DM, et al. Constipation in postmenopausal women. Article in Portuguese. Rev Assoc Med Bras. 2005;51(6):334-341. 9. Mayo Clinic. Constipation. Accessed September 13, 2021. https://www.mayoclinic.org/diseases-conditions/constipation/symptoms-causes/syc-20354253

    Diagnostic tools: Distinguishing occasional vs chronic constipation

    The criteria below may help when diagnosing patients1,2

    While there’s no formal definition for occasional constipation, it can include1

    • Infrequent bowel movements
    • Difficulty in passing stool
    • Straining
    • The feeling of incomplete evacuation

    Chronic constipation is defined by Rome III criteria2:

    • Presence of 2 or more of the following symptoms:

                ⁃ Straining during ≥25% of defecations
                ⁃ Lumpy or hard stools in ≥25% of defecations
                ⁃ Sensation of incomplete evacuation for ≥25% of defecations
                ⁃ Sensation of anorectal obstruction/blockage for ≥25% of defecations
                ⁃ Manual maneuvers to facilitate ≥25% of defecations (such as digital evacuation, support of the pelvic floor)
                ⁃ Fewer than 3 bowel movements a week

    • Loose stools are rarely present without the use of laxatives
    • Criteria must have been met for the previous 3 months with symptom onset at least 6 months prior to diagnosis

    The Bristol scale describes changes in bowel movement consistency3

    The Bristol scale can be used to evaluate bowel movements and helps patients describe them in an objective and minimally embarrassing manner.

    bristol_scale

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      References: 1. Bharucha AE, Dorn SD, Lembo A, Pressman A. American Gastroenterological Association medical position statement on constipation. Gastroenterology. 2013;144(1):211-217. doi:10.1053/j.gastro.2012.10.029 2. Ford AC, Moayyedi P, Lacy BE, et al. American College of Gastroenterology monograph on the management of irritable bowel syndrome and chronic idiopathic constipation. Am J Gasteroenterol. 2014;109(Suppl 1):S2-S26. 3. Lewis SJ, Heaton KW. Stool form scale as useful guide to intestinal transit time. Scand J Gastroenterol. 1997;32(9):920-924. doi: 10.3109/00365529709011203

      Comparison of OTC occasional constipation treatments

      OTC laxatives work in different ways

      OTC_comparison

      Click for more details about each treatment >

      The trademarks depicted herein are owned by their respective owners.

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        References: 1. Hammer HF, Santa Ana CA, Schiller LR, Fordtran JS. Studies of osmotic diarrhea induced in normal subjects by ingestion of polyethylene glycol and lactulose. J Clin Invest. 1989;84(4):1056-1062. doi:10.1172/ JCI114267 2. Andrews CN, Storr M. The pathophysiology of chronic constipation. Can J Gastroenterol. 2011;25(Suppl B):16B-21B. 3. DiPalma JA, DeRidder PH, Orlando RC, et al. A randomized, placebo-controlled, multicenter study of the safety and efficacy of a new polyethylene glycol laxative. Am J Gastroenterol. 2000;95(2):446-450. doi:10.1111/j.1572-0241.2000.01765.x 4. DiPalma JA, Cleveland MB, McGowan J, Herrera JL. A comparison of polyethylene glycol laxative and placebo for relief of constipation from constipating medications. South Med J. 2007;100(11):1085-1090. doi:10.1097/SMJ.0b013e318157ec8f 5. Fiorini K, Sato S, Schlachta CM, Alkhamesi NA. A comparative review of common laxatives in the treatment of constipation. Minerva Chir. 2017;72(3):265-273. doi:10.23736/S0026-4733.17.07236-4

        Not all OTC constipation treatments offer both effective results and few side effects

        Click to expand.

          BRAND1:

          MiraLAX®

          HOW IT WORKS2-4:

          • Works naturally by attracting water in the colon to ease, hydrate, and soften stool to relieve constipation
          • Generally produces a bowel movement in 1 to 3 days

          INDICATION1:

          • Occasional constipation

          CONSIDERATIONS5:

          • Works without causing harsh side effects such as gas, bloating, cramping, and sudden urgency
          • Proven safe in patients, including the elderly
          • No known clinically relevant drug-to-drug interactions
          • Patients should not use if they have kidney disease, except under the advice and supervision of a doctor

          BRAND6:

          Phillips'® Milk of Magnesia

          HOW IT WORKS6,7:

          • Draws water into the intestine to produce a bowel movement
          • Usually produces a bowel movement in 30 minutes to 6 hours

          INDICATION6:

          • Occasional constipation

          CONSIDERATIONS6,7:

          • Patients with kidney disease, a magnesium-restricted diet, or taking prescription drugs need to consult a doctor before use

          BRAND8-10:

          Dulcolax® (bisacodyl), ex-lax® and Senokot® (sennosides)

          HOW IT WORKS7-10:

          • Bisacodyl and sennosides stimulate the walls of the intestine, causing the muscles to contract and clear the bowel
          • Generally produces a bowel movement in 6 to 12 hours

          INDICATION7-10:

          • Occasional constipation

          CONSIDERATIONS8-10:

          • Do not use bisacodyl within 1 hour after taking an antacid or milk
          • Sennosides may affect how other drugs work and should be taken 2 hours before or after other drugs

          BRAND12:

          Metamucil®

          HOW IT WORKS7,13:

          • Softens and increases the bulk of digested food, making it easier for waste to travel through and leave the body
          • Generally produces an effect in 12 to 72 hours

          INDICATION12:

          • Occasional constipation

          CONSIDERATIONS7,12:

          • Can ferment in the intestine, which may cause gas and bloating
          • May affect how well other medicines work and should be taken at least 2 hours before or after prescribed medication

          BRAND14,15:

          Colace®, Phillips'® Stool Softener

          HOW IT WORKS7,14:

          •  Allows water and fats to get into the stool. This helps soften fecal material and makes defecation easier
          • Generally produces an effect in 12 to 72 hours

          INDICATION14,15:

          • Occasional constipation

          CONSIDERATIONS7:

          • Does not force passing of bowel movements

          Click to expand.

            References: 1. MiraLAX® Drug Facts. Bayer Consumer Health. 2. Andrews CN, Storr M. The pathophysiology of chronic constipation. Can J Gastroenterol. 2011;25(Suppl B):16B-21B. 3. Schiller LR, Emmett M, Santa Ana CA, Fordtran JS. Osmotic effects of polyethylene glycol. Gastroenterology. 1988;94(4):933-941. doi:10.1016/0016-5085(88)90550-1 4. Hammer HF, Santa Ana CA, Schiller LR, Fordtran JS. Studies of osmotic diarrhea induced in normal subjects by ingestion of polyethylene glycol and lactulose. J Clin Invest. 1989;84(4):1056-1062. doi:10.1172/JCI114267 5. DiPalma JA, DeRidder PH, Orlando RC, et al. A randomized, placebo-controlled, multicenter study of the safety and efficacy of a new polyethylene glycol laxative. Am J Gastroenterol. 2000;95(2):446-450. doi:10.1111/j.1572-0241.2000.01765.x 6. Phillips® Milk of Magnesia Drug Facts. Bayer Consumer Health. 7. Fiorini K, Sato S, Schlachta CM, Alkhamesi NA. A comparative review of common laxatives in the treatment of constipation. Minerva Chir. 2017;72(3):265-273. doi:10.23736/S0026-4733.17.07236-4 8. Dulcolax® Laxative Tablets Drugs Facts. Chattem, Inc. 9. ex-lax® Regular Strength Drug Facts. GSK. 10. Senokot (sennosides) Drug Summary. Accessed September 19, 2021. https://pdr.net/drug-summary/Senokot-sennosides-3182.84 11. Dulcolax. Accessed September 21, 2021. https://www.drugs.com/dulcolax.html 12. Metamucil Psyllium Fiber Supplement. Accessed September 19, 2021. https://www.metamucil.com/en-us/products/fiber-powders/sugar-free- orange-smooth 13. Metamucil FAQs. Accessed September 21, 2021. https://www.metamucil.com/en-us/faqs/metamucil-faqs 14. Colace® Regular Strength Product Information. Accessed September 19, 2021. https:// www.colacecapsules.com/products/colace-regular-strength/ 15. Phillips® Stool Softener Liquid Gels Drug Facts. Bayer Consumer Health.

            The trademarks depicted herein are owned by their respective owners.

            Medications that may cause constipation

            Many commonly used medications have constipation as a side effect.
            Depending on patients' existing medical concerns, some current treatment regimens may be the cause of their constipation symptoms

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              PRIMARY USE

              Relieve heartburn

              ACTIVE INGREDIENT

              Aluminium hydroxide

               

              PRIMARY USE

              Control epilepsy and other seizure disorders

              ACTIVE INGREDIENT

              Divalproex sodium

               

              PRIMARY USE

              Lower blood pressure

              ACTIVE INGREDIENT

              Clonidine

               

              PRIMARY USE

              Relieve symptoms of Parkinson’s disease

              ACTIVE INGREDIENT

              Levodopa, Carbidopa

               

              PRIMARY USE

              Treat symptoms of psychosis

              ACTIVE INGREDIENT

              Haloperidol, Clozapine, Risperidone

               

              PRIMARY USE

              Decrease intestinal cramps, control overactive bladder

              ACTIVE INGREDIENT

              Dicyclomine hydrochloride, oxybutynin chloride, tolterodine tartrate

               

              PRIMARY USE

              Reduce cholesterol

              ACTIVE INGREDIENT

              Colestipol hydrochloride

               

              PRIMARY USE

              Treat cancer

              ACTIVE INGREDIENT

              Pemetrexed disodium, carboplatin

               

              PRIMARY USE

              Lower blood pressure, promote excretion of water

              ACTIVE INGREDIENT

              Furosemide, Spironolactone, Hydrochlorothiazide, triamterene

               

              PRIMARY USE

              Iron deficiency Anemia

              ACTIVE INGREDIENT

              Ferrous Sulfate

               

              PRIMARY USE

              Relieve pain

              ACTIVE INGREDIENT

              Morphine sulfate, Codeine Phosphate, Oxycodone Hydrochloride

               

              This represents a small sample of brand name products, some of which may no longer be available. The trademarks depicted in this table are the property of their respective owners.

              Click to expand.

                References: 1. Aluminum hydroxide; magnesium hydroxide; simethicone. Accessed September 19, 2021. https://my.clevelandclinic.org/health/drugs/19931-aluminum-hydroxide-magnesium-hydroxide-simethicone-oral- suspension 2. Gaviscon® Tablets. Accessed September 19, 2021. https://www.gaviscon.com/products/tablets.html 3. Depakote®. Prescribing information. Abbvie Inc.; 2021. 4. Catapres-TTS®. Prescribing information. Boehringer Ingelheim Pharmaceuticals, Inc.; 2011. 5. Rytary. Prescribing information. Amneal Pharmaceuticals LLC; 2019. 6. Haldol®. Package insert. Ortho-McNeil Pharmaceutical, Inc.; 2009. 7. Clozaril®. Prescribing information. Novartis Pharmaceuticals Corporation; 2020. 8. Risperdal® Consta®. Prescribing information. Ortho-McNeil-Janssen Pharmaceuticals, Inc.; 2010. 9. Bentyl®. Prescribing Information. Axcan Pharma US, Inc.; 2011. 10. Ditropan XL®. Prescribing information. Janssen Pharmaceuticals, Inc.; 2016. 11. Detrol® LA. Prescribing information. Pharmacia & Upjohn Company; 2018. 12. Colestid®. Package insert. Pharmacia & Upjohn Company; 2017. 13. Alimta. Prescribing information. Eli Lilly and Company; 2004. 14. Paraplatin®. Package insert. Bristol-Myers Squibb Company; 2010. 15. Furosemide. Package insert. Hospira, Inc.; 2016. 16. Aldactazide®. Package insert. G.D. Searle; 2014. 17. Dyazide. Prescribing information. GlaxoSmithKline; 2020. 18. Slow Fe® Drug Facts. GSK. 19. MS Contin®. Prescribing information. Purdue Pharma L.P.; 2016. 20. Butalbital, Acetaminophen, Caffeine, and Codeine Phosphate. Prescribing information. Teva Pharmaceuticals USA, Inc.; 2019. 21. Percocet®. Package insert. Par Pharmaceutical; 2020. 22. OxyContin®. Prescribing information. Purdue Pharma L.P.; 2018.