Management approach for patients with persistent unresponsive constipation

This is the author's approach to the management of severe chronic idiopathic constipation. There are limited studies directly comparing various treatment options. Refer to drug monographs for additional details, including dose adjustments (eg, for kidney impairments or side effects).

* Plecanatide has the same mechanism of action as linaclotide. Generally, if the patient does not respond to one, we do not try the other.

¶ Misoprostol can be used in patients who are nonresponsive to other agents in whom surgery is being considered. Avoid misoprostol in patients who are pregnant or of childbearing potential.

Δ A newer nonpharmacologic option is the vibrating capsule. It appears to be safe and effective but may be limited in availability. This can be prescribed at any point in the treatment algorithm, particularly for patients who prefer nonpharmacologic therapy.

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Management approach for patients with persistent unresponsive constipation