Initial management of chronic constipation in adults

This algorithm shows the treatment of chronic constipation and is applicable to patients with chronic idiopathic constipation as well as those with secondary constipation (eg, due to medications) after secondary causes have been modified to the extent possible. Initial management begins with dietary and lifestyle modification. For patients with persistent symptoms, a daily osmotic laxative is added first, followed by a stimulant laxative as needed. For patients with ongoing symptoms, clinical re-evaluation is necessary. GI referral is indicated for patients with alarm symptoms and should be considered for patients with signs or symptoms of defecatory dysfunction. Secretagogue therapy can be added for patients with persistent symptoms despite adherence to optimally dosed osmotic and stimulant laxatives.