Recommendation 6: In adults with CIC, the panel suggests the use of senna over management without senna (conditional recommendation, low certainty of evidence).

Implementation considerations While the trials were conducted for 4 weeks, longer term use is probably appropriate, but data are needed to better understand tolerance and side effects. The dose evaluated in trials is higher than commonly used doses in practice. The panel suggests starting at a lower dose and increase if there is no response. Abdominal pain and cramping may occur with a higher dose of senna.