Editing Constipation (section)

==Treatment==
A limited number of cases require urgent medical intervention or will result in severe consequences.<ref name=AGA2013/>

The treatment of constipation should focus on the underlying cause if known. The National Institute of Health and Care Excellence (NICE) break constipation in adults into two categories: chronic constipation of unknown cause, and constipation due to opiates.<ref>{{cite web|title=Constipation overview|url=http://pathways.nice.org.uk/pathways/constipation|publisher=National Institute for Health and Care Excellence|access-date=10 October 2015|url-status=live|archive-url=https://web.archive.org/web/20150908041215/http://pathways.nice.org.uk/pathways/constipation|archive-date=8 September 2015}}</ref>

In chronic constipation of unknown cause, the main treatment involves the increased intake of water and fiber (either dietary or as supplements).<ref name=AGA2000/> The routine use of laxatives or enemas is discouraged, as having bowel movements may come to be dependent upon their use.<ref>{{cite web |url=https://www.lecturio.com/concepts/constipation/| title=Constipation|website=The Lecturio Medical Concept Library |access-date= 10 July 2021}}</ref>

=== Fiber supplements ===
Soluble fiber supplements such as [[psyllium]] are generally considered first-line treatment for chronic constipation, compared to insoluble fibers such as wheat bran. Side effects of fiber supplements include bloating, flatulence, diarrhea, and possible [[malabsorption]] of iron, calcium, and some medications. However, patients with opiate-induced constipation will likely not benefit from fiber supplements.<ref name=AmericanGATReview>{{Cite journal|last1=Bharucha|first1=Adil E.|last2=Pemberton|first2=John H.|last3=Locke|first3=G. Richard|title=American Gastroenterological Association Technical Review on Constipation|journal=Gastroenterology|volume=144|issue=1|pages=218–238|doi=10.1053/j.gastro.2012.10.028|pmc=3531555|pmid=23261065|year=2013}}</ref>

===Laxatives===
If [[laxatives]] are used, [[milk of magnesia]] or [[polyethylene glycol]] are recommended as first-line agents due to their low cost and safety.<ref name=AGA2013/> Stimulants should only be used if this is not effective.<ref name=AGA2000/> In cases of chronic constipation, polyethylene glycol appears superior to [[lactulose]].<ref>{{cite journal |vauthors=Lee-Robichaud H, Thomas K, Morgan J, Nelson RL | title = Lactulose versus Polyethylene Glycol for Chronic Constipation. | journal = Cochrane Database of Systematic Reviews | issue = 7 | pages = CD007570 | date = 7 July 2010 | pmid = 20614462 | doi=10.1002/14651858.CD007570.pub2}}</ref> [[Prokinetic agent|Prokinetic]]s may be used to improve gastrointestinal motility. A number of new agents have shown positive outcomes in chronic constipation; these include [[prucalopride]]<ref>{{cite journal |vauthors=Camilleri M, Deiteren A | title = Prucalopride for constipation | journal = Expert Opin Pharmacother | volume = 11 | issue = 3 | pages = 451–61 | date = February 2010 | pmid = 20102308 | doi = 10.1517/14656560903567057 | s2cid = 207478370 }}</ref> and [[lubiprostone]].<ref>{{cite journal |vauthors=Barish CF, Drossman D, Johanson JF, Ueno R | title = Efficacy and safety of lubiprostone in patients with chronic constipation | journal = Dig. Dis. Sci. | volume = 55 | issue = 4 | pages = 1090–7 | date = April 2010 | pmid = 20012484 | doi = 10.1007/s10620-009-1068-x | s2cid = 23450010 }}</ref> [[Cisapride]] is widely available in third world countries, but has been withdrawn in most of the west. It has not been shown to have a benefit on constipation, while potentially causing cardiac arrhythmias and deaths.<ref>{{Cite journal|issue = 1|pages = CD007780|last1=Aboumarzouk|first1=Omar M|last2=Agarwal|first2=Trisha|last3=Antakia|first3=Ramez|last4=Shariff|first4=Umar|last5=Nelson|first5=Richard L|date=2011-01-19|language=en|doi=10.1002/14651858.cd007780.pub2|pmid = 21249695|title = Cisapride for Intestinal Constipation|journal = Cochrane Database of Systematic Reviews}}</ref>

===Enemas===

[[Enema]]s can be used to provide a form of mechanical stimulation. A large volume or high enema<ref>{{cite web |url=https://www.merriam-webster.com/medical/high%20enema|title=high enema |work=Medical Dictionary |publisher=Merriam-Webster |access-date=17 February 2018}}</ref> can be given to cleanse as much of the colon as possible of feces,<ref>{{cite web |url=http://intranet.tdmu.edu.ua/data/kafedra/internal/meds/prac_skills_alg/Care%20of%20patients/Administering%20an%20Enema.htm |title=Administering an Enema |work=Care of patients |date=14 July 2015 |publisher=Ternopil State Medical University |access-date=17 February 2018 |archive-date=23 February 2018 |archive-url=https://web.archive.org/web/20180223111015/http://intranet.tdmu.edu.ua/data/kafedra/internal/meds/prac_skills_alg/Care%20of%20patients/Administering%20an%20Enema.htm }}</ref><ref>{{cite web |url=http://www.peoi.org/Courses/Coursesen/nursepractice/ch/ch12e1.html |title=Types of Enemas |work=Fundamentals of Nursing Practice |publisher=Professional Education, Testing and Certification Organization International |author= Rhodora Cruz |access-date=17 February 2018}}</ref> and the solution administered commonly contains [[castile soap]] which irritates the colon's lining resulting in increased urgency to defecate.<ref name=Safety_and_effectiveness>{{cite journal|title=Safety and effectiveness of large-volume enema solutions |author=Marilee Schmelzer |author2=Lawrence R.Schiller |author3=Richard Meyer |author4=Susan M.Rugari |author5=PattiCase |date=November 2004 |journal=Applied Nursing Research |doi=10.1016/j.apnr.2004.09.010 |volume=17 |issue=4 |pages=265–274|pmid= 15573335}}</ref> However, a low enema is generally useful only for stool in the rectum, not in the intestinal tract.<ref>{{cite web |url=https://www.merriam-webster.com/medical/low%20enema|title=low enema |work=Medical Dictionary |publisher=Merriam-Webster |access-date=17 February 2018}}</ref>

===Physical intervention===
Constipation that resists the above measures may require physical intervention such as manual disimpaction (the physical removal of impacted stool using the hands; see [[fecal impaction]]).

===Regular exercise===
Regular [[exercise]] can help improve chronic constipation.<ref>{{cite web|author=Canberra Hospital – Gastroenterology Unit|title=constipation|url=http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Constipation|url-status=live|archive-url=https://web.archive.org/web/20130717074139/http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Constipation|archive-date=17 July 2013}}</ref>

=== Surgical intervention ===
In refractory cases, procedures can be performed to help relieve constipation. [[Sacral nerve stimulation]] has been demonstrated to be effective in a minority of cases. [[Colectomy]] with ileorectal [[anastomosis]] is another intervention performed only in patients known to have a slow colonic transit time and in whom a defecation disorder has either been treated or is not present.<ref name="AGA2013"/> Because this is a major operation, side effects can include considerable abdominal pain, small bowel obstruction, and post-surgical infections. Furthermore, it has a very variable rate of success and is very case dependent.<ref name=AmericanGATReview/>