What are the recommended first-line treatments for adults with chronic constipation?

Offer a bulk-forming laxative first-line, such as ispaghula, for adults with chronic constipation. (1)

Gradually titrate the laxative dose to produce soft, formed stool without straining at least three times per week, and review the person according to need. (1)

If these measures are ineffective, consider adding or switching to an osmotic laxative, such as macrogol (polyethylene glycol). (1)

Consider naldemedine if other laxative treatments have been ineffective. (1)

For opioid-induced constipation, do not prescribe bulk-forming laxatives; instead, offer an osmotic laxative and a stimulant laxative. (1)