TABLE 2.
Comments and conclusions derived from the recommendations on chronic constipation
|
Recommendation* |
Comments | ||
|---|---|---|---|
| Quality | Level | ||
| Bulk-forming agents | |||
| Dietary | Uncertain | D | Gradual increase favourable |
| Psyllium | Effective | B | Better evidence for psyllium than bran |
| Stool softeners | |||
| Docusate | Insufficient | C | |
| Osmotic laxatives | |||
| Milk of Magnesia | Effective | C | Avoid in patients with renal insufficiency |
| Polyethylene glycol | Effective | A | Unpalatable taste |
| Lactulose | Effective | B | May cause bloating, flatulence and cramping |
| Stimulant laxatives | |||
| Short term | Effective | C | May be associated with abdominal cramping and unpredictable nonformed stools |
| Long term | No evidence | – | May lead to need for increasing posology |
| Lubiprostone and linaclotide are new agents to promote intestinal secretion | |||
| Prokinetic agents | |||
| Domperidone | Insufficient | D | Withdrawn from Canadian market in 2007 |
| Tegaserod† | Effective | A | Prucalopride is a new prokinetic agent |
| Glycerine suppositories | Effective | C | Initiates evacuation by distending the rectum |
| Biofeedback | Effective | B | Useful in patients with pelvic floor dysfunction |
| Hypnotherapy/cognitive behavioural therapy | Effective | B | In selected patients after proper diagnostic investigation |
*
Refer to reference 7 for definitions pertaining to the quality of recommendations and levels of evidence;
†
Withdrawn from the Canadian market in 2007