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The treatment of constipation involves a variety of approaches, including traditional laxatives, novel pharmacological agents, and herbal medicines. While traditional laxatives like PEG and senna are effective, novel agents such as prucalopride and linaclotide offer additional options for patients with chronic constipation. Herbal medicines like MZRW and SHTB provide alternative treatments with promising results. Complementary therapies may also be beneficial, particularly for elderly patients. Further research is needed to validate the long-term efficacy and safety of these treatments.
Constipation is a prevalent gastrointestinal disorder that significantly impacts the quality of life. It can be caused by various factors, including dietary habits, neurological conditions, and slow colonic transit. The treatment of constipation often involves lifestyle modifications, over-the-counter (OTC) medications, prescription drugs, and complementary and alternative medicine (CAM). This article reviews the efficacy and safety of various treatments for constipation, including traditional laxatives, novel pharmacological agents, and herbal medicines.
Traditional Laxatives
Traditional laxatives are commonly used to manage constipation. They can be classified into several categories, including osmotic laxatives, stimulant laxatives, and fiber supplements.
Osmotic Laxatives
Polyethylene glycol (PEG) is an osmotic laxative that has been shown to be effective in treating chronic constipation. A systematic review found good evidence supporting the use of PEG, with a grade A recommendation for its efficacy and safety3 4.
Stimulant Laxatives
Senna and bisacodyl are stimulant laxatives that increase bowel motility. Senna has been recommended as a first-line treatment for constipation due to its efficacy3. Bisacodyl, another stimulant laxative, was found to be highly effective in a network meta-analysis, ranking first in efficacy at 4 weeks7.
Fiber Supplements
Psyllium is a fiber supplement that has moderate evidence supporting its use in treating constipation. It works by increasing stool bulk and promoting bowel movements3 4.
Novel Pharmacological Agents
Recent advancements in pharmacology have introduced new drugs for treating constipation, particularly for patients who do not respond to traditional laxatives.
Prucalopride
Prucalopride is a selective 5-hydroxytryptamine receptor agonist that has shown efficacy in improving spontaneous complete bowel movements (SCBM) with minimal adverse events2. It ranked first in efficacy at 12 weeks in a network meta-analysis, suggesting it is highly effective for chronic idiopathic constipation7.
Linaclotide
Linaclotide is a guanylate cyclase-C agonist that has demonstrated significant improvement in bowel evacuation and symptom resolution in patients with irritable bowel syndrome with constipation (IBS-C)2. It is considered a safe and effective treatment option.
Lubiprostone
Lubiprostone activates type-2 chloride channels, increasing intestinal fluid secretion and improving bowel movements. Clinical trials have shown that lubiprostone is effective in increasing SCBM and is well-tolerated2.
Herbal Medicines
Herbal medicines have been used for centuries to treat constipation, particularly in traditional Chinese medicine (TCM).
MaZiRenWan (MZRW)
MaZiRenWan (MZRW) is a Chinese herbal medicine that has been used for over 2000 years. A randomized controlled trial found that MZRW significantly increased complete spontaneous bowel movements (CSBM) compared to placebo and was well-tolerated1. It also showed improvements in colonic transit and reduced severity of constipation symptoms.
Shouhui Tongbian Capsules (SHTB)
Shouhui Tongbian Capsules (SHTB) have been evaluated in a systematic review and meta-analysis, showing significant improvements in total effective rate, clinical symptom scores, and gastrointestinal peptide hormone indices. SHTB was found to be effective and safe for treating functional constipation8.
Other Herbal Medicines
Rhubarb, senna leaf, and aloe are commonly used herbal medicines for constipation. These herbs contain anthraquinone compounds, which have significant laxative effects by promoting gastrointestinal motility9. However, more research is needed to fully understand their efficacy and safety.
Complementary and Alternative Medicine (CAM)
CAM therapies, such as probiotics, biofeedback, and massage, have been explored for treating constipation, particularly in the elderly. These therapies are generally easy to use and have few adverse reactions, making them promising adjunctive treatments5.