Bharucha, A.E., Pemberton, J.H., & Locke, G.R., 3rd. (2013). American Gastroenterological Association technical review on constipation. Gastroenterology, 144, 218–238.

To identify rational, effective, and cost-effective treatment approaches for patients with constipation.

In this evidence-based guideline, material was selected from reviews and focused literature searches of peer-reviewed published studies.

Databases searched, search keywords, and inclusion criteria were not stated.

Studies were excluded if they reported on children or patients with constipation as a secondary symptom caused by problems such as spinal cord injury.
 

The study has clinical applicability to older adult and palliative care.

Evidence was categorized according to the U.S. Preventive Services Task Force grading system. Rome II criteria were used to define constipation. The resource identified causes of constipation, approaches for assessment, and recommendations for management based on evidence review. In addition to opiates, other causative agents associated with constipation in patients with cancer were antidepressants, anticholinergic agents, vinca alkaloids, vincristine, and cyclophosphamide.

• No evidence suggests increasing fluid intake improves constipation.
• Increased physical activity is associated with less constipation.
• Data are limited regarding the impact of probiotics on constipation.
• Dietary fiber has potential therapeutic benefits, and fiber supplementation should be considered as a first step in patients with chronic constipation. However, the quality of evidence in this area is low.
• If needed, osmotic agents should be used regularly and supplemented with stimulant laxatives as rescue medication, although the quality of evidence is moderate at best.

Limited high-quality evidence exists for effective interventions in managing constipation.