HelixTalk Episode #102 - When the Squatty Potty Isn’t Enough: Drug Therapy for Chronic Idiopathic Constipation

Date posted: October 1, 2019, 6:00 am

In this episode, we provide an overview of chronic idiopathic constipation and discuss available treatment options with a particular focus on lubiprostone, linaclotide, plecanatide, and prucalopride.

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Key Concepts

1. Proper assessment and evaluation is the key for a patient with complaints about constipation.  Ask questions to ensure there are no red flags (such as blood in stool, severe pain, or fever).  Most patients with chronic idiopathic constipation (CIC) have had symptoms for many years before seeking treatment from a medical provider.
2. The most important non-pharmacologic treatment for constipation is fiber.  In general, few Americans consume the recommended amount of fiber (20 to 30 grams per day) in their diet.  Be sure to increase dietary fiber slowly to avoid gastrointestinal discomfort.
3. Currently there are four prescription medications indicated for CIC that offer three distinct mechanisms.  For the secretagogues (lubiprostone, linaclotide, plecanatide), proper hydration (and avoidance of dehydration) is extremely important as these medications increase excretion of water into the GI tract.

References

American Gastroenterological Association, Bharucha AE, Dorn SD, et al. American Gastroenterological Association medical position statement on constipation. Gastroenterology. 2013 Jan;144(1):211-7. doi: 10.1053/j.gastro.2012.10.029.