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Occasional constipation can be defined as occasional or intermittent symptomatic alterations in the bowel habit.
Based on expert consensus recommendations, a recent study proposed a new definition for occasional constipation. The goal of researchers was to describe the process of creating and putting forth a new definition for occasional constipation on the basis of expert consensus and taking into account the multifactorial nature of the issue, including potential treatment responsiveness, the length of symptoms, the sufferer's perception, and changes in bowel habits like frequency of stools and difficulty passing them.
Leading gastroenterologists from five nations virtually discussed the issue of occasional constipation using a digital forum and suggested a useful, user-friendly definition: "occasional constipation is characterized by sporadic or intermittent symptomatic changes in bowel habits". This involves an uncomfortable decrease in bowel movement frequency and/or difficulty passing stool, but there are no worrisome symptoms. Bowel symptoms may last for a few weeks or a few days, and to resolve episodes, it may be necessary to change one's diet, lifestyle, or use of over-the-counter bulking agents or laxatives.
Since the majority of people who experience occasional constipation won't visit a doctor, any management recommendations or guidelines should be greatly disseminated and accessible via public channels and pharmacies. It should provide information that is reliable and convey crucial advice on consulting a doctor when worrying symptoms or constipation start to worsen. Patients who have occasional constipation do not form a single homogenous group.
It is more probable that responses to therapy, severity of the symptoms, and the cause will differ. Due to the subjective nature of each person's constipation experience, determining the severity of constipation is challenging. Therefore, it could be better to assess the effects of constipation on the individual and assess what types of treatments or activities they have already tried. The most practical treatment strategy may be one that bases care on a course of action likely to alleviate important symptoms while taking into account the patient's preferences (patient-centricity).
Any future therapy recommendations should include lifestyle advice (exercise, diet), since lifestyle plays a significant role in occasional constipation, even if it may take some time for these changes to take effect. When creating any guidelines, selecting a course of therapy for occasional constipation is likely to be a "one-shot" decision and systematic, step-by-step treatment programmes will be less beneficial and might lead to poor adherence. Making decisions should also take into account what to avoid, such as high insoluble fibre consumption in people who experience bloating.
Fiber has long been utilized to alleviate digestive issues including constipation. Although increasing dietary fibre could gradually help those who have occasional constipation, some may want a quicker solution. Occasional constipation is typically not treated with prescription drugs due to the sporadic nature of the symptoms. Patients with chronic idiopathic constipation (CIC) are more likely to need ongoing therapy with either over-the-counter or prescription drugs. Therefore, it is believed that prescription drugs have little to no role in mitigating occasional constipation.
In the treatment of chronic constipation, prokinetic drugs and/or intestinal secretagogues, stimulants and/or osmotic laxatives, and dietary fibre supplements are frequently used first. Peripherally acting μ-opiate antagonists are a choice for opioid-stimulated constipation.
A systematic review of the effectiveness and safety of over-the-counter (OTC) treatments for chronic constipation found strong support for the use of stimulant senna and osmotic laxative polyethylene glycol, moderate evidence for yogurt with galactooligosaccharide/prunes/linseed oil, fruit-based laxatives (figs, prunes, mango, kiwi), stimulants (sodium picosulfate, bisacodyl), magnesium salts, SupraFiber, and psyllium (ispaghula); and insufficient evidence for using fructo-oligosaccharide, inulin, and polydextrose.
Any first recommendations for managing occasional constipation will unavoidably be based on clinical expertise and, if available, data from occasional constipation trials. Another approach would be to create and implement a campaign to increase awareness of occasional constipation while highlighting the benefits and drawbacks of the treatment available.
Through such a programme, pharmacists may be encouraged to interact with customers to gain a better knowledge of their symptoms, as well as to explore more about patients' treatment choices and the prevalence and effects of occasional constipation. Current knowledge gaps were identified and may serve as a catalyst for future research to advance the understanding of occasional constipation and the formation of evidence-based management recommendations.
The American Journal of Gastroenterology
Recognizing and Defining Occasional Constipation: Expert Consensus Recommendations
Satish S.C. Rao et al.
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