Mx of constipation in adults: lifestyle changes + first-line pharmacological tre

Management of constipation in adults includes lifestyle modifications and pharmacological treatments.

Lifestyle modifications:

• Encourage adequate fluid intake, aiming for at least 1.5 litres per day unless contraindicated, to help soften stools and prevent dehydration.
• Advise a balanced diet with sufficient dietary fibre, including fruits, vegetables, wholegrain cereals, and high-fibre bread, to promote regular bowel movements.
• Promote regular physical activity tailored to the individual's ability to support bowel motility.
• Encourage establishing a regular bowel habit, including responding promptly to the urge to defecate and using scheduled toileting after meals to utilize the gastrocolic reflex.
• Ensure toilet facilities are private, comfortable, and accessible, and advise adopting a sitting or squatting position to facilitate bowel evacuation.

Pharmacological treatments:

• First-line pharmacological treatment is usually osmotic laxatives such as polyethylene glycol (macrogol) preparations, which increase stool water content and ease passage.
• If osmotic laxatives are not effective or tolerated, stimulant laxatives (e.g., senna or bisacodyl) may be added or substituted to stimulate colonic motility.
• For hard stools, stool softeners such as docusate or lactulose can be considered.
• Continue laxative treatment at maintenance doses for several weeks or months after regular bowel habits are established, and reduce doses gradually to avoid relapse.

These management strategies should be tailored to the individual’s symptoms, preferences, and response to treatment, with ongoing support and information provided.

References: ¹,²