The goal of treatment for CIC is to reduce the frequency of constipation. However, treatment is not the same for everyone. The best treatment for you will depend on how severe your CIC is and how well it responds to different types of treatment.
Treatment often starts with lifestyle changes. This may include changing your diet, increasing fluid intake and adding exercise.
For instance, you might need to increase the amount of fiber you're consuming by adding more whole grains, vegetables and fruits to your daily diet. As you increase fiber, though, it's important to also increase your fluid intake. Try to drink six to eight cups of water every day. Also, adding fiber gradually should limit side effects like bloating. You may want to work with a dietitian to develop an eating plan that promotes bowel health.
As for exercise, being inactive is a risk factor for constipation. Ask your doctor what type and amount of exercise would be best for you.
If CIC doesn't improve with lifestyle changes, your doctor may suggest you try supplements or laxatives that you can buy at your local pharmacy.
- Bulk laxatives: These supplements are made from fibers that do not get digested. They also absorb water. They help your colon form more bulky and easy-to-pass stool. Research has shown these to be safe and effective, but it's important to drink sufficient amounts of water when using these. Side effects may include bloating and flatulence. Common types include psyllium and methylcellulose.
- Osmotic laxatives: If a bulk laxative does not help, the next choice is usually an osmotic laxative. These laxatives draw water into the colon. They include molecular substances such as lactulose, polyethylene glycol and magnesium hydroxide. Side effects can include bloating, diarrhea and dehydration.
- Stimulant laxatives: These are used less often than other laxatives because they can cause cramps and nausea. They work by increasing water absorption into the colon and stimulating muscle contractions of the colon. Common examples include bisacodyl, senna and sodium picosulfate.
If you have constipation that does not respond to a laxative, your doctor may suggest what's called a rescue treatment, such as a glycerin suppository or enema.
If lifestyle changes and laxatives don't help, the next step is usually prescription-strength drugs approved to treat CIC. These are oral medications that you'd take daily. The main side effect is diarrhea. These drugs work by increasing fluid in the colon. Common examples include lubiprostone, linaclotide and plecanatide, which was just approved in 2017.
Along with lifestyle changes, laxatives and medications, some people with CIC benefit from such treatments as biofeedback and bowel retraining.
- Bowel retraining: For this, you'll need to change some habits. For instance, you'll need to eat meals at about the same time every day. You'll also learn to plan a bowel movement at the same time every day—a time when you don’t have to rush. Often the best time is about 30 minutes after a meal. Some people find that drinking a hot liquid will stimulate a bowel movement. Your doctor, a nurse or a physical or occupational therapist will work with you to find what changes work best for you.
- Biofeedback: Having a bowel movement involves coordination of your nervous system and muscle functions. This is something that's normally regulated automatically by your body, but biofeedback teaches you to consciously control the process. The treatment is painless and usually requires several weekly sessions. It uses a computer and video monitor to display graphs or sounds to represent bodily functions that it picks up from sensors on your body. A health care professional trained in biofeedback helps you use this information to change your response to these functions.