Chronic idiopathic constipation (CIC) is a functional gastrointestinal disorder diagnosed based on symptoms and the absence of structural gastrointestinal abnormalities. No definitive biomarker exists for identifying CIC. CIC is a common condition with a large proportion of patients trying more than one OTC medication for relief of constipation symptoms. In addition to bowel symptoms, many patients with CIC also experience abdominal symptoms such as pain, bloating, discomfort, gassiness, fullness, and stomach cramps. CIC has a significant negative impact on patients’ health-related quality of life. The major worry in CIC is uncertainty about symptom onset, the persistence of symptoms. Individuals with symptoms of CIC typically make self-guided dietary changes and use stool softeners or OTC laxatives, possibly at the direction of a healthcare provider, before prescription medications for CIC are initiated. Several types of OTC laxatives are commonly used, including osmotic agents (polyethylene glycol [PEG] and lactulose), bulk-forming agents (psyllium husk and wheat dextrin), and stimulants (senna and bisacodyl). Patients who do not respond to OTC medications may seek the assistance of a healthcare provider who can initiate therapy with a prescription medication. Several prescription medications are now available for the treatment of adults with CIC, including linaclotide, lubiprostone, plecanatide, and lactulose. Linaclotide, lubiprostone, and plecanatide are approved specifically for CIC and lactulose is approved for chronic constipation by the US Food and Drug Administration and for CIC by other regulatory agencies. Across medications, insufficient relief of bowel symptoms was the most commonly cited reason (17–40%) for treatment discontinuation, followed by insufficient relief of abdominal symptoms (9–23%), side effects (6–13%), and cost (2–4%). Bisacodyl consistently had the highest levels of satisfaction among the treatments followed by Senna and PEG.

Source: Lacy BE et al., PLoS One. 2021;16(1):e0243318.