Management of constipation: A narrative review of evolving strategies and methodological challenges

doi:10.5662/wjm.118399

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World Journal of Methodology

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2222-0682

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Methodol. Sep 20, 2026; 16(3): 118399
Published online Sep 20, 2026. doi: 10.5662/wjm.118399

Management of constipation: A narrative review of evolving strategies and methodological challenges

Manjeet Kumar Goyal, Gayatri Brahmandam, Rishi Chowdhary, Sowmya Durga Subhasri Guna, Dhruvi Shah, Prerna Goyal, Ashita Rukmini Vuthaluru, Omesh Goyal

Manjeet Kumar Goyal, Department of Internal Medicine, Cleveland Clinic Akron General Hospital, Akron, OH 44308, United States

Gayatri Brahmandam, Department of Internal Medicine, Adichunchanagiri Institute of Medical Sciences, Mandya 571448, Karnātaka, India

Rishi Chowdhary, Department of Medicine, MetroHealth Medical Center, Cleveland, OH 44109, United States

Sowmya Durga Subhasri Guna, Department of Internal Medicine, Mayo Clinic, Jacksonville, FL 32224, United States

Dhruvi Shah, Department of Internal Medicine, University of Maryland Medical Center Midtown Campus, Maryland, MD 21201, United States

Prerna Goyal, Department of Medicine, R.G. Stone Super Speciality Hospital, Ludhiana 141001, Punjab, India

Ashita Rukmini Vuthaluru, Department of Anesthesiology, All India Institute of Medical Sciences, New Delhi 110029, India

Omesh Goyal, Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana 141001, Punjab, India

Co-first authors: Manjeet Kumar Goyal and Gayatri Brahmandam.

Author contributions: Goyal MK and Chowdhary R contributed to the conceptualization of the study, made crucial and indispensable contributions towards the completion of the project, and thus qualified as the co-first authors of the paper; Goyal MK, Chowdhary R, Goyal P, and Brahmandam G developed the methodology; Brahmandam G, Shah D, and Subhasri Guna SD generated the visualization of the data; Chowdhary R, Goyal MK, Brahmandam G, Vuthaluru AR, and Subhasri Guna SD drafted the manuscript; Goyal O provided supervision and validation of the study; All authors contributed to the review and editing of the manuscript and approved the final version. The efforts by Goyal MK and Brahmandam G were performed at each step outlined above in equal collaboratory efforts, without which the study would not have been completed.

AI contribution statement: We did not use any tools related to AI. We have verified the manuscript using Turnitin, and the report does not indicate the presence of AI-generated content.

Conflict-of-interest statement: The authors have no conflicts of interest to declare.

Corresponding author: Omesh Goyal, MD, DM, Department of Gastroenterology, Dayanand Medical College and Hospital, Tagore Nagar, Ludhiana 141001, Punjab, India. dromeshgoyal@gmail.com

Received: December 31, 2025
Revised: January 26, 2026
Accepted: February 25, 2026
Published online: September 20, 2026
Processing time: 191 Days and 16.1 Hours

Core Tip

Core Tip: Chronic constipation is a heterogeneous disorder encompassing distinct pathophysiologic phenotypes, including normal-transit constipation, slow-transit constipation, defecatory disorders, and a broad range of secondary organic causes. Failure to recognize these subtypes contributes to suboptimal treatment responses and inconsistent outcomes in both clinical practice and trials. Accurate diagnosis requires a structured, stepwise approach integrating careful history, targeted physical examination, and selective use of physiologic and imaging investigations. Management should be phenotype-driven, combining lifestyle measures, pharmacologic therapy, and pelvic floor-directed interventions when appropriate. Emphasizing mechanism-based evaluation and individualized treatment strategies is essential to improve long-term outcomes and reduce unnecessary therapeutic escalation.