title: Chronic constipation: an evidence-based review.
abstract: BACKGROUND
  Chronic constipation is a common condition seen in family practice among the elderly and women. There is no consensus regarding its exact definition, and it may be interpreted differently by physicians and patients. Physicians prescribe various treatments, and patients often adopt different over-the-counter remedies. Chronic constipation is either caused by slow colonic transit or pelvic floor dysfunction, and treatment differs accordingly.
  
  
  METHODS
  To update our knowledge of chronic constipation and its etiology and best-evidence treatment, information was synthesized from articles published in PubMed, EMBASE, and Cochrane Database of Systematic Reviews. Levels of evidence and recommendations were made according to the Strength of Recommendation taxonomy.
  
  
  RESULTS
  The standard advice of increasing dietary fibers, fluids, and exercise for relieving chronic constipation will only benefit patients with true deficiency. Biofeedback works best for constipation caused by pelvic floor dysfunction. Pharmacological agents increase bulk or water content in the bowel lumen or aim to stimulate bowel movements. Novel classes of compounds have emerged for treating chronic constipation, with promising clinical trial data. Finally, the link between senna abuse and colon cancer remains unsupported.
  
  
  CONCLUSIONS
  Chronic constipation should be managed according to its etiology and guided by the best evidence-based treatment.
authors: Department of Family Medicine, Queen's University, Kingston, Ontario, Canada. leungl@queensu.ca
authors: Lawrence
authors: L
authors: Leung
authors: Taylor
authors: T
authors: Riutta
authors: Jyoti
authors: J
authors: Kotecha
authors: Walter
authors: W
authors: Rosser
mesh_terms: D001676:Biofeedback, Psychology; D002908:Chronic Disease; D000529:Complementary Therapies; D003248:Constipation / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D019317:Evidence-Based Medicine; D005194:Family Practice; D005260:Female; D006801:Humans; D054368:Laxatives / Q000627:therapeutic use; D008019:Life Style
chemical_list: D054368:Laxatives