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

Figure 1 Etiology of constipation. Overview of the major pathophysiologic contributors to chronic functional constipation, including neurologic, behavioral, psychological, dietary, medication-related, structural, metabolic, and microbiome-associated factors. The figure illustrates the multifactorial and often overlapping mechanisms underlying symptom development. ADHD: Attention-deficit hyperactivity disorder.

Figure 2 Treatment options for constipation in adults. Summary of available treatment modalities for chronic functional constipation, including lifestyle and dietary interventions, over-the-counter laxatives, prescription pharmacologic therapies, and emerging nonpharmacologic strategies. Treatment selection is guided by symptom severity, prior treatment response, and suspected underlying pathophysiology. IBAT: Ileal bile acid transporter.

Figure 3 Workflow in diagnosing and treating functional constipation in adults. Proposed clinical algorithm for the evaluation and management of chronic functional constipation, beginning with exclusion of secondary and organic causes, followed by empiric therapy and escalation based on treatment response. Physiologic testing, including colonic transit studies and anorectal function testing, is incorporated to distinguish normal-transit constipation, slow-transit constipation, and defecatory disorders, thereby guiding targeted therapy. CTT: Colonic transit time; FED: Fecal evacuation disorder; IBS-C: Irritable bowel syndrome with constipation.