Consensus statement AIGO/SICCR diagnosis and treatment of chronic constipation and obstructed defecation (Part II: Treatment)

Table 1 Classes of drugs used to treat chronic constipation

Type of medication	Drugs
Laxatives
Bulking (insoluble and soluble fibres)	Bran, methylcellulose, psyllium
Osmotic	Lactulose, sorbitol, magnesium hydroxide, magnesium salts, polyethylene glycol
Stimulant	Anthraquinone derivatives: senna, aloe, cascara
	Diphenylmethane derivatives: bisacodyl, sodium picosulfate
Softening	Liquid paraffin (vaseline oil), docusate, glycerine
Serotoninergic enterokinetic agents	Tegaserod, prucalopride, renzapride
Prosecretory agents	Lubiprostone, linaclotide
Gastrointestinal μ-opioid antagonists	Methylnaltrexone, alvimopan
Probiotics	Bifidobacterium, lactobacillus
Colchicine

Table 2 Levels of evidence and grades of recommendation of medical treatment in chronic constipation

	Level of evidence	Grade of recommendation
Life style
Physical exercise	V	C
Toilet training	V	C
Increased fluid intake	V	C
Bulking laxatives
Insoluble fibre	III	C
Soluble fibre: Psyllium	II	B
Osmotic laxatives
Lactulose	II	B
Sorbitol	V	C
Magnesium hydroxide/magnesium salts	V	C
Polyethylene glycol	I	A
Stimulant laxatives
Sodium picosulfate, bisacodyl	I	B
Senna, aloe, cascara	V	C
Softening laxatives
Docusate	V	C
Serotoninergic enterokinetics
Tegaserod	I	A1
Prucalopride	I	A
Prosecretory agents
Lubiprostone	I	B2
Linaclotide	I	B3
Gastrointestinal μ-opioid antagonists
Methylnaltrexone	I(no effect)	A (not used)
Alvimopan	I(no effect)	A (not used)2
Probiotics	V	C
Colchicine	III	C
Procedures to empty the rectum-sigma
Peristeen®	V	C

¹Food and Drug Administration prescribing restrictions;

²Not approved in Europe;

³Phase II study. Adapted from: American College of Gastroenterology Chronic Constipation Task Force[184]; and Rao[249].