The World Gastroenterology Organisation recommends that the first step in the general management of constipation involves a detailed history and physical examination. The type of constipation should be ascertained in patients, vis, normal-transit/constipation predominant irritable bowel syndrome (IBS); slow-transit; evacuation disorder; idiopathic/organic/secondary constipation.

The guidelines suggested that medical approach must be adopted in normal-transit constipation even in the absence of alarm symptoms, with fiber, milk of magnesia, polyethylene glycol (PEG) or lactulose, and bisacodyl or sodium picosulphate; medications should be titrated based on individual needs. In patients with treatment-resistant constipation, specialized investigations may be required. A majority of patients with normal or negative clinical evaluation meet the criteria for constipation-predominant IBS and often benefit from treatment with fiber and/or osmotic laxatives.

It was further stated that patients with slow-transit constipation must be investigated for anatomic defects. Treatments for slow-transit constipation include fiber, milk of magnesia, bisacodyl or sodium picosulphate, and prucalopride or lubiprostone. PEG or lactulose should be added in the case of absence of improvement.

On the other hand, a few highly-selected patients with refractory constipation may benefit from surgery. PEG, 17 g for 14 days, was recommended for patients with chronic constipation where dietary approach has failed, in order to promote bowel function.