Chronic Constipation

Effectiveness of abdominal massage on chronic constipation in adults: A systematic review and meta-analysis.

Huang SY, Chiao CY, Chien LY · International journal of nursing studies · 2025 · n=1431

Chronic constipation is a common distressing symptom. Abdominal massage is a safe, noninvasive, and comfortable intervention. However, it is rarely used in formal clinical practice as its' effectiveness for chronic constipation remains unclear. This systematic review aimed to investigate the effectiveness of abdominal massage on defecation frequency, stool consistency, colonic transit time, constipation symptoms, quality of life, laxative use, and adverse events in adults. Additionally, we aimed to compare the effectiveness of abdominal massage in chronic constipation with different etiologies and types of abdominal massage techniques. Data from eight English and Chinese electronic databases until May 15, 2024, including randomized controlled trials (RCT) and quasi-experimental studies, were used. The risk of bias was assessed using the Cochrane risk-of-bias tool. Results were synthesized using a random-effect model. This study was registered on the 7th of January 2023 to the Interna

Systematic review and meta-analysis: Foods, drinks and diets and their effect on chronic constipation in adults.

Van Der Schoot A, Katsirma Z, Whelan K, Dimidi E · Alimentary pharmacology & therapeutics · 2024 · n=1714

Dietary approaches are recommended for the management of chronic constipation. Until now, there has been no systematic review and meta-analysis on foods, drinks and diets in constipation. To investigate the effect of foods, drinks and diets on response to treatment, stool output, gut transit time, symptoms, quality of life, adverse events and compliance in adults with chronic constipation via a systematic review and meta-analysis. Studies were identified using electronic databases (12th July 2023). Intervention trials (randomised controlled trials [RCTs], non-randomised, uncontrolled) were included. Risk of bias was assessed using Cochrane 2.0 (RCTs) or JBI Critical Appraisal (uncontrolled trials). Data from RCTs only were synthesised using risk ratios (RRs), mean differences (MDs), standardised mean differences (95% CI) using random-effects. We included 23 studies (17 RCTs, 6 uncontrolled; 1714 participants): kiwifruit (n = 7), high-mineral water (n = 4)

Comparative profiles of lubiprostone, linaclotide, and elobixibat for chronic constipation: a systematic literature review with meta-analysis and number needed to treat/harm.

Rao SS, Manabe N, Karasawa Y, Hasebe Y, Nozawa K, Nakajima A · BMC gastroenterology · 2024

To comprehensively evaluate the efficacy, safety, patient symptoms, and quality-of-life (QoL) of lubiprostone, linaclotide, and elobixibat as treatment for chronic constipation (CC). Systematic literature review (SLR) and meta-analysis (MA). Literature searches were conducted on PubMed and Embase using the Ovid platform. SLR including randomized controlled trials (RCTs) and observational studies was conducted to identify the overall efficacy and safety of lubiprostone, linaclotide, and elobixibat. Thereafter, MA was performed using only RCTs. The number needed to treat (NNT) and number needed to harm (NNH) analyses were additionally conducted. The primary outcome was efficacy regarding change in spontaneous bowel movements. Secondary outcomes included safety, constipation-related symptoms, and QoL. Twenty-four studies met the inclusion criteria for the SLR: 17 RCTs, 4 observational studies, and 3 single-arm trials. Feasibility assessment for the MA resulted in 14 studies available

Efficacy and Safety of Over-the-Counter Therapies for Chronic Constipation: An Updated Systematic Review.

Rao SSC, Brenner DM · The American journal of gastroenterology · 2021

Constipation is commonly treated with over-the-counter (OTC) products whose efficacy and safety remain unclear. We performed a systematic review of OTC therapies for chronic constipation and provide evidence-based recommendations. We searched PubMed and Embase for randomized controlled trials of ≥4-week duration that evaluated OTC preparations between 2004 and 2020. Studies were scored using the US Preventive Services Task Force criteria (0-5 scale) including randomization, blinding, and withdrawals. The strengths of evidence were adjudicated within each therapeutic category, and recommendations were graded (A, B, C, D, and I) based on the level of evidence (level I, good; II, fair; or III, poor). Of 1,297 studies identified, 41 met the inclusion criteria. There was good evidence (grade A recommendation) for the use of the osmotic laxative polyethylene glycol (PEG) and the stimulant senna; moderate evidence (grade B) for psyllium, SupraFiber, magnesium salts, stimulants (bisac

Chronic constipation: A review of literature.

Forootan M, Bagheri N, Darvishi M · Medicine · 2018

Chronic constipation is described as a common complication determined by difficult and/or rare passage of stool or both. The difference in definition of constipation has led to a wide range of reported prevalence (i.e., between 1% and 80%). Various factors are involved in the pathogenesis of the disease, including type of diet, genetic predisposition, colonic motility, absorption, social economic status, daily behaviors, and biological and pharmaceutical factors. Diagnostic and therapeutic options play a key role in the treatment of chronic constipation. There are still debates about the timing of these diagnostic and therapeutic algorithms. A systematic and comprehensive search will be performed using MEDLINE, PubMed, EMBASE, AMED, the Cochrane Library and Google Scholar. Better understanding of the pathophysiology of chronic constipation and efficacy of pharmacological agent can help physicians for treating and managing symptoms.In this study, some of the old and new therapies in th

Constipation in children: fibre and probiotics.

Tabbers MM, Benninga MA · BMJ clinical evidence · 2015

Prevalence of childhood constipation has been estimated at 1% to 30% in the general population worldwide; most children have no obvious aetiological factors. One third of children with chronic constipation continue to have problems beyond puberty. Half of the children with chronic faecal impaction and faecal incontinence have experienced an episode of painful defecation, and many children with chronic constipation exhibit withholding behaviour. We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of fibre for children with chronic constipation? What are the effects of probiotics for children with chronic constipation? We searched: Medline, Embase, The Cochrane Library, and other important databases up to May 2014 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administrati

AGA Clinical Practice Update on Evaluation and Management of Refractory Constipation: Expert Review.

Staller K, Neshatian L, Lembo A, Bharucha AE · Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association · 2026

Although most patients with chronic constipation respond to medical therapy, a subset experiences refractory constipation (RC), which poses unique diagnostic and therapeutic challenges. Because RC is relatively rare, clinicians should systematically (1) exclude correctable secondary causes such as medications, neurologic disorders, and defecatory disorders (DDs); (2) confirm the presence of slow colonic transit; and (3) ensure that patients have undergone adequate trials of over-the-counter and Food and Drug Administration-approved medications and nonpharmacologic therapies, including combinations thereof. Surgical treatments, such as colectomy, may be considered in patients who fail available treatments. However, surgical treatment of chronic constipation is associated with increased risk of complications and a not insignificant number of unsatisfactory outcomes. Prior to advising surgery, it is essential to confirm slow colonic transit, exclude concurrent DDs, and evaluate for severe

[Seoul Consensus on Clinical Practice Guidelines for Functional Constipation].

Song KH, Cho YS, Shin JE, Jung HK, Park SY, Kang SJ · The Korean journal of gastroenterology = Taehan Sohwagi Hakhoe chi · 2025

Chronic constipation is one of the most common digestive diseases encountered in clinical practice. Constipation manifests as a variety of symptoms, such as infrequent bowel movements, hard stools, feeling of incomplete evacuation, straining at defecation, a sense of anorectal blockage during defecation, and use of digital maneuvers to assist defecation. During the diagnosis of chronic constipation, the Bristol Stool Form Scale, colonoscopy, and a digital rectal examination are useful for objective symptom evaluation and differential diagnosis of secondary constipation. Physiological tests for functional constipation have complementary roles. They are recommended for patients who have failed to respond to treatment with available laxatives and those who are strongly suspected of having a defecatory disorder. As new evidence on diagnosing and managing functional constipation emerged, the need to revise the previous guideline was suggested. Therefore, these evidence-based guidelines have

British Dietetic Association Guidelines for the Dietary Management of Chronic Constipation in Adults.

Dimidi E, van der Schoot A, Barrett K, Farmer AD, Lomer MC, Scott SM · Neurogastroenterology and motility · 2025

Current clinical guidelines for chronic constipation offer limited dietary recommendations. The aim of this project was to develop the first comprehensive evidence-based dietary guidelines for the management of chronic constipation in adults. Four systematic reviews and meta-analyses were performed to identify eligible randomized controlled trials (RCTs). The findings generated from the meta-analyses were then used to develop guideline statements using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach and a Delphi consensus survey among a multidisciplinary expert Guideline Steering Committee. Recommendation statements were produced for treatment response, stool output, gut symptoms, adverse events, and quality of life, and only based on the findings where ≥ 2 RCTs contributed to the meta-analysis. The strength of recommendation was assessed using the GRADE approach. Consensus voting among the Guideline Steering Committee was performe

Efficacy of a postbiotic and its components in promoting colonic transit and alleviating chronic constipation in humans and mice.

Ma T, Li Y, Yang N, Wang H, Shi X, Liu Y · Cell reports. Medicine · 2025 · n=110

This study evaluates the efficacy of the postbiotic Probio-Eco in alleviating constipation in humans and mice. A randomized, double-blind, placebo-controlled crossover trial involving 110 adults with chronic constipation (Rome IV criteria) demonstrates that a 3-week Probio-Eco intervention significantly improves constipation symptoms, stool straining, and worry scores. Gut microbiota and metabolomic analyses reveal modulations in specific gut microbiota, succinate, tryptophan derivatives, deoxycholate, propionate, butyrate, and cortisol, correlating with symptom relief. A loperamide-induced mouse model confirms that Probio-Eco and its bioactive components (succinate, 3-indoleacrylic acid, and 5-hydroxytryptophan) alleviate constipation by stimulating mucin-2 secretion, regulating intestinal transport hormones, and promoting anti-inflammatory responses. Multi-omics integration identifies key pathways, including succinate-short-chain fatty acid, tryptophan-5-hydroxytryptophan-serotonin,

Supervised exercise and pelvic floor muscle training eases current pelvic and genital pain but not worst pelvic and genital pain in women with endometriosis: a randomised trial.

Gabrielsen R, Tellum T, Bø K, Engh ME, Frawley H, Nedregård Tveito S · Journal of physiotherapy · 2025 · n=41

How much does adding supervised group and independent individual exercise including pelvic floor muscle training (PFMT) to multidisciplinary pain management affect pelvic and genital pain in women with endometriosis? How much does it affect dyspareunia, dysuria, quality of life (with emphasis on psychological distress, including symptoms of depression and anxiety), symptoms of chronic constipation and pelvic floor muscle (PFM) function? A two-armed, parallel-group, randomised controlled trial with concealed allocation, intention-to-treat analysis and blinded assessment of some outcomes. Women aged 18 to 45 years with laparoscopically confirmed endometriosis experiencing pelvic/genital pain. All participants attended a pain management course. The exercise group (n = 41) then performed weekly supervised general exercise training including PFMT for 4 months, and home training two to three times/week. The control group (n = 40) received no further intervention. Primary outcomes were th

Effects of Transcutaneous Auricular Vagal Nerve Stimulation on Chronic Constipation: A Multicenter, Randomized Controlled Study.

Liu T, Wang Z, Li Y, Kang X, Wang X, Ren G · United European gastroenterology journal · 2025 · n=106

The objective of this study was to investigate the efficacy of transcutaneous auricular vagal nerve stimulation (taVNS) in adult patients with chronic constipation. Consecutive patients who met the Rome IV criteria for chronic constipation were enrolled and randomly assigned to either the taVNS group or the sham-taVNS group. Treatment consisted of 30 min of therapy twice a day for 4 weeks. The primary outcome was the response rate at week 1-4, defined as the proportion of patients with a weekly complete spontaneous bowel movement (CSBM) of ≥ 3 and weekly excessive use of rescue medication ≤ 3 times. Secondary outcomes included spontaneous bowel movements, anxiety and depression scores, abdominal symptoms, and adverse events. The study was terminated due to lack of efficacy revealed by the interim analysis. A total of 106 patients were randomized, with 52 participants in the taVNS group and 54 participants in the sham-taVNS group. After 4 weeks o

Vesicoureteral Reflux.

Leslie SW, Aeddula NR · 2026

Management of Chronic Constipation: A Comprehensive Review.

Hojo M, Shibuya T, Nagahara A · Internal medicine (Tokyo, Japan) · 2025

Traditionally, the treatment of chronic constipation has focused on lifestyle modification, dietary guidance and therapy, and osmotic and stimulant laxatives. Recently, several drugs with new mechanisms of action have been introduced as treatments for chronic constipation. In Japan, polyethylene glycol and lactulose can now be administered under insurance coverage. The number of treatment options for constipation has increased dramatically. First, lifestyle modifications and dietary therapies must be implemented. If constipation does not improve sufficiently, specialized functional tests are performed to diagnose physiological subgroups. If functional tests are not available, patients are classified as having the "decreased frequency of defecation" type or the "difficult defecation" type based on the patient's symptoms, with treatment applied according to each type. Medical therapy includes osmotic laxatives, secretagogues, bile acid transporter inhibitors, probiotics, prokinetics, and

Evidence-Based Clinical Guidelines for Chronic Constipation 2023.

Ihara E, Manabe N, Ohkubo H, Ogasawara N, Ogino H, Kakimoto K · Digestion · 2025

The Japan Gastroenterological Association published the first version of its clinical guidelines for chronic constipation 2023. Based on the latest evidence, these guidelines describe the definition, classification, diagnostic criteria, diagnostic testing methods, epidemiology, pathophysiology, and treatment of chronic constipation. They include flowcharts for both diagnosis and treatment of chronic constipation. In the treatment of chronic constipation, the first step involves differentiating between secondary forms, such as organic disease-associated constipation, systemic disease-associated constipation, and drug-induced constipation. The next step is to determine whether the chronic constipation stems from a motility disorder, a form of primary chronic constipation. For functional constipation and constipation-predominant irritable bowel syndrome, treatment should be initiated after evaluating symptoms like reduced bowel movement frequency type or defecation difficulty type. The fi

Constipation

NHS

The National Health Service (NHS) in the UK provides practical health information for the public, including details on the symptoms, causes, diagnosis, and treatments for constipation. It also offers advice on self-care and when to see a doctor.

A Phase 2, Randomized, Double-blind, Placebo-controlled, Multiple Dose, Parallel Group Study to Evaluate the Pharmacodynamics, Efficacy and Safety of RM-131 Administered to Patients With Parkinson's Disease and Chronic Constipation Dissatisfied With Current Therapy

n=18 · NCT01955616 · TERMINATED · TERMINATED

The purpose of this study, called MOVE-PD, is to investigate how individuals with Parkinson's disease (PD) and chronic constipation (CC) respond to RM-131 as compared to placebo. The study will look at how well RM-131 affects the frequency of spontaneous bowel movements over a 14-day period. The study will also evaluate the safety and tolerability of the study drug and evaluate whether the study drug relieves the uncomfortable GI symptoms related to chronic constipation in patients who are unsatisfied with other therapies they have tried for constipation.

Colon Transit Study for Assessment of Chronic Constipation and Therapy Directed Against Fecal Evacuation Disorder by Biofeedback With or Without Transcutaneous Electrical Stimulation of Posterior Tibial Nerve

n=50 · NCT05946967 · UNKNOWN · UNKNOWN

One of the most challenging functional gastrointestinal illnesses (FGID) to manage is constipation, which is a widespread issue. The fact that constipation can be caused by a variety of conditions, including slow colon transit, faecal evacuation disorder, or a combination of both slow colon transit and faecal evacuation disorder, is one of the main reasons it is challenging to treat. Treatment options vary based on the pathogenetic mechanism; for instance, biofeedback, botulinum toxin injections in the puborectal sling, or transcutaneous electrical nerve stimulation (TENS) are required to treat faecal evacuation problem. On the other hand, prucalopride and other colokinetic drugs as well as drugs that promote high amplitude propagating contractions, including bisacodyl and sodium pyrosulphate, are used to treat slow transit constipation. Sometimes faecal evacuation disorders that inhibit the evacuation of the transit markers can cause slow colon transit times; these secondary sluggish colon transit times have been shown to improve with biofeedback therapy alone. Even though the causes of faecal evacuation disorders are not fully understood, it is known that abnormal neuromuscular function is the result. A few workers have stimulated the posterior tibial nerve, another sacral plexus branch, non-invasively with TENS. Studies on the use of biofeedback in the treatment of patients with faecal evacuation problems are lacking. Accordingly, we wish to undertake a prospective study with following aims: (i) To assess safety and efficacy of colon transit study by an indigenous radio opaque marker to identify the mechanism of constipation and to assess outcome of treatment (improvement of transit time). (ii) To assess the efficacy of pathogenesisdirected therapy such as biofeedback with or without TENS for posterior tibial nerve to treat fecal evacuation disorder. (iii) To assess colon transit following treatment of fecal evacuation disorder with either biofeedback alone or biofeedback with TENS for posterior tibial nerve.

Evaluation of Fecal Microbiome Changes After Antegrade Continence Enema Placement and Initiation of Bowel Flush Regimen

n=65 · NCT05821309 · RECRUITING · RECRUITING

This study will evaluate changes in the fecal microbiome in constipated pediatric patients before and after antegrade continence enema placement and initiation of antegrade enema flushes. Subjects will have their microbiome sequenced prior to placement by obtaining a fecal sample. Pre-antegrade continence enema placement results will be compared to fecal samples obtained at 0, 4, 8 months after placement of the antegrade continence enema and initiation of miralax or golytely flushes to look for changes in bacterial diversity.

Cochrane colorectal cancer screening group publications (search 'constipation')

Cochrane

The Cochrane Library provides systematic reviews and meta-analyses on various medical topics, including interventions for constipation. It is a leading source for evidence-based healthcare information.

TRIP Database- search: chronic constipation

TRIP Database

TRIP is a clinical search engine designed to allow users to quickly and easily find high-quality research evidence to support their practice. A search for 'chronic constipation' yields relevant guidelines, systematic reviews, and primary research.