OTC guide to constipation. Start with a high-fiber diet (20–35 g/day) or fiber supplements like psyllium, and maintain hydration and regular exercise. Osmotic laxatives such as polyethylene glycol (PEG) are first-line pharmacologic options for softening stools and improving motility. For persistent symptoms, stimulant laxatives like senna or bisacodyl may be used, with enemas reserved for severe cases.
January 9, 2025

Constipation Treatment

Evidence-Based Over-the-Counter Guide

William Shen

William Shen

Co-founder & CPO

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Nonpharmacological treatment of chronic constipation includes a high-fiber diet, increased fluid intake, exercise, and healthy bowel habits: scheduling toileting for 10–15 minutes in the morning and ∼ 30 minutes after each meal to coincide with the gastrocolic reflex.

Pharmacological treatment begins with osmotic laxatives, which help retain water in the GI tract to keep stools soft, and can be escalated with stimulant laxatives which cause the GI lining to secrete fluids back into the stool and decrease transit time of contents through the GI tract. 

First-line recommendations:

  • Dietary fiber supplements: 20–35 g of dietary fiber daily, from high fiber-containing foods and/or bulk-forming laxatives (e.g., psyllium). Recommended product (FDA M007).

  • Osmotic laxatives: draws water into the GI tract to hydrate stools and stimulate intestinal motility. Best initial treatment is polyethylene glycol (PEG). Start with 17 g or less dissolved in one cup of water daily as needed. PEG osmotic laxative (FDA NDA 22015). 

Second-line recommendations:

  • Senna: Stimulant laxative. Begin with 1-2 tablets per day at nighttime, as needed. Sennoside laxative 8.6 mg (FDA M007). 

  • Bisacodyl: Stimulant laxative. Begin with 1 tablet per day at nighttime, as needed. Recommended product (FDA M007). 

  • Mineral-oil or saline enema: Effective for occasional severe constipation. Works by hydrating the rectum and softening stools to provide gentle constipation relief. Recommended product (FDA M007).

Prescription medications:

  • Prokinetic agents: Lubiprostone (8 mcg twice daily) or linaclotide (145 mcg once daily) for chronic idiopathic constipation.

  • Methylnaltrexone: For opioid-induced constipation in patients unresponsive to traditional laxatives. Dose: Weight-based subcutaneous injection every other day.

Citations:

Bharucha AE, Pemberton JH, Locke GR 3rd. American Gastroenterological Association technical review on constipation. Gastroenterology. 2013; 144(1): p.218-38. doi: 10.1053/j.gastro.2012.10.028

Mounsey A, Raleigh M, Wilson A. Management of Constipation in Older Adults. Am Fam Physician. 2015.

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