This summary highlights the results of research on constipation and treatment options and combines them into a simple diagram to help guide and provide a best practice pathway for general practice in its recognition, treatment, and point of escalation for the available therapies for chronic constipation. For further information, please view the full guidance together with the NICE Clinical Knowledge Summary on constipation.

Algorithm 1: Bowel dysfunction treatment pyramid

Bowel Dysfunction Treatment Pyramid

Algorithm 1: Bowel dysfunction treatment pyramid. Adapted with permission from Professor Anton Emmanuel

Constipation—best practice for treatment

The starting point for treatment is at the base of the pyramid with standard interventions, such as laxatives and dietary changes. However, effective bowel management requires a pathway that first tests those conservative interventions, and then if they are ineffective over a strictly limited period, moves regularly up the pyramid until the patient’s condition comes under control.

Other stages in the pyramid include transanal irrigation. It causes more complete than normal bowel evacuation, helping users to remain continent between regular irrigations.

After transanal irrigation more complex and permanent interventions may be required, such as stoma. It is important to move as quickly as possible to the appropriate therapy level to fundamentally improve the patient’s ability to live a normal and fulfilling life.

For further information, please visit bowelinterestgroup.co.uk/resources.

Full guideline: The Bowel Interest Group. Dealing with chronic constipation, information for general practitioners. BIG, 2020. Available from: bowelinterestgroup.co.uk/resources/dealing-with-chronic-constipation-information-for-general-practitioners.

First published: 03 March 2020.