Lifestyle Modifications

Generally, OIC management begins with increased fluid intake and physical exercise, which should be initiated at the beginning of treatment.4 Fiber can be helpful, but beware of bulking agents, warns Dr. Fudin, because increased bulk in the presence of decreased fluid, motility, and sphincter tone, can lead to more constipation or even bowel obstruction.

Stimulant Laxatives and Stool Softeners

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Lifestyle modifications are rarely sufficient to alleviate OIC, so laxatives are typically required. The most common regimen utilizes gastrointestinal stimulants (eg, senna or bisacodyl) and the three types of stool softeners: surfactants (eg, docusate), lubricants (eg, mineral oil), and osmotics (eg, lactulose).4

Some drawbacks of stimulant laxatives are potential dependence and depletion of magnesium, Dr. Fudin cautions.

Secretagogues promote intestinal secretion, soften stools, and accelerate intestinal transit.5 Lubiprostone is a selective chloride channel activator that increases intraluminal sodium and water6 and is FDA approved for use in OIC in patients with non-cancer pain.  Linaclotide, a guanylate cyclase-C agonist, is not currently FDA-approved for the indication of OIC.5

The effectiveness of these agents is limited by the fact that they do not target the specific mechanisms of OIC, notes Dr. Fudin.