Table 4.
Recommendations and Evidence of Lifestyle Changes, Dietary Suggestions, and Exercise for Chronic Constipation According to the Different Guidelines
| European GL | French GL | Spanish GL | Korean GL | |
|---|---|---|---|---|
| Lifestyle | Overall lifestyle modifications have a positive effect ● Evidence: Moderate ● Recommendation: Strong ● Agreement:100% |
Behavioural rules (daily presentation to the toilet, optimal position on the toilet, environmental conditions) ● Positive effect ● Expert Recommendation |
NA | NA |
| Diet | Increase of fiber intake has positive effect, especially if combined with fluid increase ● Evidence: Low ● Recommendation: Weak ● Agreement 92% |
Increase of fiber intake has positive effect. Dried plums have a better efficacy than psyllium in mild to moderate constipation ● Evidence II, Grade B ● Consumption of foods other than fiber: not positive not negative effect ● Expert Recommendation ● Overeating has positive effect only in undernourished patients ● Expert Recommendation |
Consuming high fiber foods has a positive effect ● Evidence: Moderate ● Recommendation: Strong |
Dietary fiber has a positive effect. Evidence: C ● Recommendation: 2 ● Experts’ agreement: completely agree: 27.6%; mostly agree:72.4% ● It can be an initial strategy ● Evidence: C. ● Recommendation: 2. ● Experts’ agreement: completely agree: 35.7%, mostly agree: 60.7%; partially agree: 3.6% |
| Increase of fluid intake | Positive effects only in dehydrated patients ● Evidence: Low ● Recommendation: Strong ● Agreement: 100% |
Positive effect in dehydrated patients or in those assuming fiber ● Expert Recommendation ● Positive effect of water rich in magnesium ● Level II, Grade B |
Positive effect only if associated with fiber supplement ● Evidence: Low ● Recommendation: Weak |
Positive effect in dehydrated patients or when bulking agents are added ● Evidence: C ● Recommendation: 1 ● Experts’ agreement completely agree: 37.0%; mostly agree: 55.6%;partially agree: 7.4% |
| Exercise | Not positive not negative effect on constipation ● Evidence: Moderate ● Recommendation: Strong ● Agreement: 92% |
Not positive not negative effect on constipation ● Expert Recommendation |
Positive effect ● Evidence: Low ● Recommendation weak |
Positive effect. ● Evidence: C ● Recommendation: 2 ● Experts’ agreement: completely agree: 7.1%, mostly agree: 67.9%, partially agree: 14.3%, mostly disagree: 10.7% |
Abbreviation: NA, not assessed.