Constipation is a widespread condition
that impacts quality
of life1

42 million people suffer from the discomfort of constipation each year2

8 out of 10 people
80% of people will experience constipation at some point in their lifetime3

Female patients are more likely than males to experience constipation4

Woman
Hormones, diet, supplemental iron, pregnancy, and menopause are all factors that may lead to constipation in women5-9

Constipation symptoms can interrupt patients' daily lives1

~70%
of people had difficulty working, and at least 1 in 10 people miss work or school completely due to chronic constipation

Unresolved constipation can lead to long-term consequences2

calendar
Untreated chronic constipation can lead to more serious health problems such as hemorrhoids, anal fissures, rectal prolapse, or fecal impaction
References: 1. Johanson JF, Kralstein J. Chronic constipation: a survey of the patient perspective. Aliment Pharmacol Ther. 2007;25(5):599-608. 2. National Institute of Diabetes and Digestive and Kidney Disease. Definition and facts for constipation. National Institute of Diabetes and Digestive and Kidney Diseases website. https://www.niddk.nih.gov/health-information/digestive-diseases/constipation/definition-facts. Updated May 2018. Accessed July 2, 2018. 3. Papanikolaou Y, Fulgoni VL. The effect of wheat bran on various measures of bowel function and regularity. In: van der Kamp JW, Jones JM, McCleary BV, Topping DL, eds. Dietary Fibre: New Frontiers for Food and Health. Wageningen, Netherlands: Wageningen Academic Publishers; 2010:261-281. 4. McCrea GL, Miaskowski C, Stotts NA, Macera L, Varma MG. A review of the literature on gender and age differences in the prevalence and characteristics of constipation in North America. J Pain Symptom Manage. 2009;37(4):737-745. 5. Vlitos AL, Davies GJ. Bowel function, food intake and the menstrual cycle. Nutr Res Rev. 1996;9(1):111-134. 6. National Institutes of Health. Iron fact sheet for health professionals. National Institutes of Health website. https://ods.od.nih.gov/factsheets/Iron-HealthProfessional. Updated March 2, 2018. Accessed June 20, 2018. 7. Bradley CS, Kennedy CM, Turcea AM, Rao S, Nygaard IE. Constipation in pregnancy: prevalence, symptoms, and risk factors. Obstet Gynecol. 2007;110(6):1351-1357. 8. Gjerdingen DK, Froberg DG, Chaloner KM, McGovern PM. Changes in women's physical health during the first postpartum year. Arch Fam Med. 1993;2(3):277-283. 9. Oliveira SC, Pinto-Neto AM, Conde DM, et al. Constipation in postmenopausal women. [Article in Portuguese]. Rev Assoc Med Bras. 2005;51(6):334-341.

Distinguishing constipation:
Occasional vs chronic

The criteria below may help when diagnosing patients1,2

While there's no formal definition for occasional constipation, it can include

  • Infrequent bowel movements
  • Difficult passage of stool
  • Straining
  • The feeling of incomplete evacuation

Chronic constipation is defined by Rome III criteria:

  • Presence of 2 or more of the following symptoms:
    • Straining during ≥25% of defecations
    • Lumpy or hard stools in ≥25% of defecations
    • Sensation of incomplete evacuation for ≥25% of defecations
    • Sensation of anorectal obstruction/blockage for ≥25% of defecations
    • Manual maneuvers to facilitate ≥25% of defecations (such as digital evacuation, support of the pelvic floor)
    • Fewer than 3 bowel movements a week
  • Loose stools are rarely present without the use of laxatives
  • Criteria must have been met for the previous 3 months with symptom onset at least 6 months prior to diagnosis

The Bristol scale describes changes in bowel movement consistency3

The Bristol scale can be used to evaluate bowel movements and helps patients describe them in an objective and minimally embarrassing manner.

Bristol stool scale
References: 1. Bharucha AE, Dom SD, Lembo A, Pressman A; American Gastroenterological Association. American Gastroenterological Association medical position statement on constipation. Gastroenterology. 2013;144(1):211-217. 2. Ford AC, Moayeddi P, Lacy BE, et al; for the Task Force on the Management of Functional Bowel Disorders. American College of Gastroenterology monograph on the management of irritable bowel syndrome and chronic idiopathic constipation. Am J Gastroenterol. 2014;109(8)(suppl 1):S2-S26. 3. Lewis SJ, Heaton KW. Stool form scale as a useful guide to intestinal transit time. Scand J Gastroenterol. 1997;32(9):920-924.

Recommend
MiraLAX® Logo first

Not all OTC constipation treatments offer both effective results and few side effects

BRAND1:

MiraLAX

HOW IT WORKS1-3:
  • Works naturally by attracting water in the colon to ease, hydrate, and soften stool to relieve constipation
  • Generally produces a bowel movement in 1 to 3 days
INDICATION1:

Occasional constipation

CONSIDERATIONS4,5:
  • Will not cause harsh side effects such as gas, bloating, cramping, and sudden urgency
  • Proven safe in patients, including the elderly
  • No known clinically relevant drug-to-drug interactions
  • Do not use if you have kidney disease, except under the advice and supervision of a doctor
BRAND6:

Phillips'® Milk of Magnesia

HOW IT WORKS6:
  • Draws water into the intestine to produce a bowel movement
  • Usually produces a bowel movement in 30 minutes to 6 hours
INDICATION6:

Occasional constipation

CONSIDERATIONS6,7:
  • Offers cramp-free, gentle relief without the use of harsh stimulants
  • The only overnight relief liquid with an ingredient that is easy on the digestive system
  • Patients with kidney disease, a magnesium-restricted diet, or taking prescription drugs need to consult a doctor before use
BRAND8-10:

Dulcolax® (bisacodyl), Ex-Lax® and Senokot® (sennosides)

HOW IT WORKS8-10:
  • Bisacodyl and sennosides stimulate the walls of the intestine, causing the muscles to contract and clear the bowel
  • Generally produces a bowel movement in 6 to 12 hours
INDICATION7-10:

Occasional constipation

CONSIDERATIONS8-10:
  • Do not use Bisacodyl within 1 hour after taking an antacid or milk
  • Sennosides may affect how other drugs work and should be taken 2 hours before or after other drugs
BRAND11:

Metamucil®

HOW IT WORKS7,11:
  • Softens and increases the bulk of digested food, making it easier for waste to travel through and leave the body
  • Generally produces an effect in 12 to 72 hours
INDICATION11:

Occasional constipation

CONSIDERATIONS7,11:
  • Can ferment in the intestine, which may cause gas and bloating
  • May affect how well other medicines work and should be taken at least 2 hours before or after prescribed medication
BRAND12,13:

Colace®, Phillips'® Stool Softener

HOW IT WORKS7,12,13:
  • Allows water and fats to get into the stool. This helps soften fecal material and makes defecation easier
  • Generally produces an effect in 12 to 72 hours
INDICATION12,13:

Occasional constipation

CONSIDERATIONS7:
  • Does not force passing of bowel movements

The trademarks depicted in this table are owned by their respective owners.

References: 1. MiraLAX Drug Facts. Bayer Consumer Health. 2. Schiller LR, Emmett M, Santa Ana CA, Fordtran JS. Osmotic effects of polyethylene glycol. Gastroenterology. 1988;94(4):933-941. 3. Hammer HF, Santa Ana CA, Schiller LR, Fordtran JS. Studies of osmotic diarrhea induced in normal subjects by ingestion of polyethylene glycol and lactulose. J Clin Invest. 1989;84(4):1056-1062. doi:10.1172/JCl114267 4. DiPalma JA, Cleveland MV, McGowan J, Herrera JL. A randomized, multicenter, placebo-controlled trial of polyethylene glycol laxative for chronic treatment of chronic constipation. Am J Gastroenterol. 2007;102(7):1436-1441. 5. Cleveland MV, Flavin DP, Ruben RA, Epstein RM, Clark GE. New polyethylene glycol laxative for treatment of constipation in adults: a randomized double-blind, placebo-controlled study. South Med J. 2001;94(5):478-481. 6. Phillips’ Milk of Magnesia Drug Facts. Bayer Consumer Health. 7. Fiorini K, Sato S, Schlachta CM, Alkhamesi NA. A comparative review of common laxatives in the treatment of constipation. Minerva Chir. 2017;72(3):265-273. 8. Dulcolax Drug Facts. Sanofi-Aventis U.S. LLC. 9. Ex-Lax Drug Facts. GlaxoSmithKlein PLC. 10. Senokot Drug Facts. Purdue Products LP. 11. Metamucil Drug Facts. Metamucil website. https://www.metamucil.com/en-us/products/metamucil-fiber-supplements/sugar-free-orange-smooth-dietary-supplement. Accessed June 14, 2018. 12. Phillips' Stool Softener Drug Facts. Bayer Consumer Health. 13. Colace Info. Colace capsules website. https://www.colacecapsules.com/Products/Colace-Regular-Strength. Accessed June 14, 2018.

Many commonly used medications have
constipation as a
side effect

Depending on patients' existing medical concerns, some current treatment regimens may be the cause of their constipation symptoms

PRIMARY USE
Relieve heartburn
ACTIVE INGREDIENT
Aluminum hydroxide
PRIMARY USE
Control epilepsy and other seizure disorders
ACTIVE INGREDIENT
Divalproex sodium
PRIMARY USE
Lower blood pressure
ACTIVE INGREDIENT
Clonidine hydrochloride
PRIMARY USE
Relieve symptoms of Parkinson's disease
ACTIVE INGREDIENTS
Levodopa, carbidopa
PRIMARY USE
Treat symptoms of psychosis
ACTIVE INGREDIENTS
Haloperidol, clozapine, risperidone
PRIMARY USE
Decrease intestinal cramps, control overactive bladder
ACTIVE INGREDIENTS
Dicyclomine hydrochloride, oxybutynin chloride, tolterodine tartrate
PRIMARY USE
Reduce cholesterol
ACTIVE INGREDIENTS
Colestipol hydrochloride
PRIMARY USE
Treat cancer
ACTIVE INGREDIENTS
Antimetabolite antineoplastic agents, alkylating agents
PRIMARY USE
Lower blood pressure, promote excretion of water
ACTIVE INGREDIENTS
Furosemide, spironolactone, hydrochlorothiazide, triamterene
PRIMARY USE
Iron deficiency anemia
ACTIVE INGREDIENT
Ferrous sulfate
PRIMARY USE
Relieve pain
ACTIVE INGREDIENTS
Morphine, codeine phosphate, oxycodone hydrochloride

This represents a small sample of brand name products, some of which may no longer be available. The trademarks depicted in this table are the property of their respective owners.

References: 1. Gaviscon tablets. Gaviscon website. https://www.gaviscon.com/products/tablets. Accessed June 13, 2018. 2. Depakote [Prescribing Information]. North Chicago, IL: AbbVie Inc; 2017. 3. Catapres-TTS [Prescribing Information]. Ridgefield, CT: Boehringer Ingelheim Pharmaceuticals, Inc; 2011. 4. Rytary [Prescribing Information]. Paterson, NJ: Impax Laboratories, Inc; 2015. 5. Haldol [Prescribing Information]. Titusville, NJ: Janssen Pharmaceuticals, Inc; 2017. 6. Clozaril [Prescribing Information]. Rosemont, PA: HLS Therapeutics (USA), Inc; 2017. 7. Risperdal Consta [Prescribing Information]. Titusville, NJ: Janssen Pharmaceuticals, Inc; 2018. 8. Bentyl [Prescribing Information]. Madison, NJ: Allergan USA, Inc; 2018. 9. Ditropan XL [Prescribing Information]. Titusville, NJ: Janssen Pharmaceuticals, Inc; 2016. 10. Detrol LA [Prescribing Information]. New York, NY: Pharmacia and Upjohn Company LLC; 2018. 11. Colestid [Prescribing Information]. New York, NY: Pharmacia and Upjohn Company LLC; 2018. 12. Alimta [Prescribing Information]. Indianapolis, IN: Lilly USA, LLC; 2018. 13. Carboplatin [Prescribing Information]. Lake Forest, IL: Hospira; 2018. 14. Lasix [Prescribing Information]. Bridgewater, NJ: Sanofi-Aventis US LLC; 2016. 15. Aldactazide [Prescribing Information]. New York, NY: G.D. Searle LLC; 2016. 16. Dyazide [Prescribing Information]. Research Triangle Park, NC: GlaxoSmithKline; 2017. 17. SlowFe. Supplement Facts. SlowFe website. https://www.slowfe.com/drug_facts?gclid=EAIaIQobChMI0tWT0cze2wIVDIvICh2QRgVQEAAYASAAEgJT9_D_BwE&gclsrc=aw.ds. Accessed June 24, 2018. 18. MS Contin [Prescribing Information]. Stamford, CT: Purdue Pharma LP; 2016. 19. Tylenol with Codeine [Prescribing Information]. Titusville, NJ: Janssen Pharmaceuticals, Inc; 2017. 20. Percocet [Prescribing Information]. Malvern, PA: Endo Pharmaceuticals, Inc; 2017. 21. OxyContin [Prescribing Information.] Stamford, CT: Purdue Pharma LP; 2016.