Chronic idiopathic constipation (CIC) is a frequently encountered functional bowel disorder, which has a great impact on the quality of life and the health care system and also depicts a heavy economic burden. It is characterized by difficult, infrequent, and/or incomplete defecation. Several therapeutic approaches have been suggested to relieve symptoms of CIC. 

The diagnosis is symptomatic, classified by the Rome IV criteria. European, French, Spanish and Korean guidelines are current therapeutic guidelines for adult CIC. 

Based on the available evidence, a high fiber diet and Osmotic laxatives particularly polyethylene glycol remains the first-line therapeutic approach. Interestingly, this approach is useful also as over-the-counter therapy.  Stimulant laxatives remains a second-line therapy.  Furthermore, in patients with anorectal dyssynergia, Pelvic floor rehabilitation is recommended. 

Patients who do not show signs of improvement with pharmacological therapies are indicated for sacral nerve stimulation as a last chance before surgery, however, the surgical approach has limited indications in selected cases. Inertia coli refractory to any approach and obstructed defecation can benefit from surgery. 

Among, newer therapies, prucalopride, a prokinetic agent, is recommended as a second-line treatment in refractory CIC patients. Further, the secretagogues linaclotide and plecanatide and the bile acid transported inhibitor elobixibat can be useful in patients not responsive to a second-line therapeutic regimen, although their commercial availability is limited globally. Literature evidence indicates that prucalopride contains the potential for being the first-line treatment for CIC and some drugs currently approved for constipation-predominant IBS might be approved also for CIC in future, due to their efficacy in this condition. 

Source: Bassotti G, Usai Satta P, Bellini M. Chronic Idiopathic Constipation in Adults: A Review on Current Guidelines and Emerging Treatment Options. Clin Exp Gastroenterol. 2021;14:413-428

https://doi.org/10.2147/CEG.S256364