Gastroenterologists Recommend 2 New Treatments for Chronic Constipation

Fact checked by Nick Blackmer

Key Takeaways

• GI health experts have added two new options to their list of recommended treatments for chronic idiopathic constipation (CIC) in adults: magnesium oxide and senna.

• Magnesium oxide and senna are both available over-the-counter (OTC).

• Eating plenty of foods that are high in fiber, drinking plenty of water, and exercising more can also help with constipation. However, if you’ve tried making lifestyle changes but are still constipated, experts recommend reaching out to your healthcare provider to talk about over-the-counter (OTC) laxatives or prescription medications.

The American College of Gastroenterology (ACG) and the American Gastroenterological Association (AGA) recently published new clinical practice guidelines for using medication to treat chronic idiopathic constipation (CIC) in adults. The effort is meant to give healthcare providers clear and practical suggestions for effectively managing the common condition.

The updated guidelines include 10 evidence-based recommendations for the treatment of CIC. Two treatments—magnesium oxide and senna—are included in the recommendations for the first time.

What Is Chronic Idiopathic Constipation?

Chronic idiopathic constipation (CIC) is a common condition that affects 8%–12% of the United States population. People with CIC can have symptoms like infrequent bowel movements, the feeling of having incomplete bowel movements, and bowel movements that are hard to pass, but unlike other kinds of constipation, the cause of CIC is not known.

Here’s what experts want you to know about managing CIC, including when to talk to your provider about medications that may help.

Learn More: What Is CIC?

What Are Magnesium Oxide and Senna?

Magnesium oxide is a type of magnesium supplement that can be used to relieve GI symptoms like heartburn and acid indigestion.

Ekta Gupta, MD, assistant professor of medicine in the Department of Gastroenterology and Hepatology at the Johns Hopkins University School of Medicine, told Verywell that magnesium oxide can also be used as an osmotic laxative to soften stools.

“The non-absorbed magnesium creates an osmotic gradient, which draws more water in the colon, making it softer and easier to pass,” said Gupta.

Senna comes from the herb Senna alexandrina and acts as a stimulant laxative, making it different from magnesium oxide.

Megan Gerber, RD, LDN, a functional and integrative dietitian/nutritionist and the founder of Grounded Nourishment, told Verywell that senna works by actively triggering contractions in the muscles of the gut to stimulate bowel movements.

Gerber said that both options are available over-the-counter (OTC) in capsule, pill, or tablet forms. Magnesium oxide also comes in a powder, and senna can be made into tea.

Learn More: How Osmotic Laxatives Work for Constipation

Why Are Experts Recommending These Treatments Now?

According to Gupta, the ACG and AGA cited two studies to support the updated recommendation that includes magnesium oxide and senna as treatment options for CIC.

For example, studies have shown that patients who used magnesium oxide had complete and more spontaneous bowel movements per week, and also reported improved quality of life. For senna, research has shown it may increase spontaneous and complete bowel movements and also improve patients’ quality of life.

Despite the findings, Gupta said the research has important limitations to think about—for example, the trials were only four weeks long and did not look at the long-term effects of these treatments.

“Given the short duration of the study, it is a conditional recommendation with very low certainty of evidence,” said Gupta, adding that the “long-term use data is also not available” for these treatments.

What does that mean for providers and patients? While there is some research to back up the inclusion of magnesium oxide and senna as recommended CIC treatments, we still need more research—preferably with more people and longer timeframes—to know for sure how safe and effective they are.

Why Did Experts Make the Recommendation If the Evidence Is Limited?

While there are limitations to the available research, other experts say that magnesium oxide and senna made the list of recommended treatments for CIC because they did show effectiveness in the studies that have been done.

“We’re still learning a lot about constipation and what causes it other than dietary changes that can be modified,” Natasha Chhabra, MD, a gastroenterologist at Gastroenterology Associates of New Jersey, told Verywell. “This is still something that’s being studied on how it can be tested and improved upon, [but] all of these medications work on improving motility.”

Chhabra added that another potential reason why both treatments are being recommended now is that they are considered more accessible and affordable for patients because they’re sold OTC and are relatively low-cost.

“The cost of managing constipation can be very high,” she said. “Although there are prescription medications available for constipation—some of which are mentioned in the guidelines—a lot of these are not available in generic form yet, so they may be at a higher cost depending on the person’s insurance plan.”

The medical costs of managing CIC range from $2,000 to $7,500 dollars per patient per year.

Learn More: Why Does Constipation Happen?

What Other Evidence-Backed Treatments for Constipation Exist?

Besides magnesium oxide and senna, the ACG and AGA also list other nonpharmacological therapies for CIC, including OTC and prescription medications that providers and patients can consider.

• Fiber: In adults with CIC, the panel recommends fiber supplements like bran, inulin, and psyllium. These options contain dietary fiber that can help regulate bowel movements and prevent constipation.

• Osmotic laxatives: The panel suggests adults with CIC use polyethylene glycol (PEG), which is an osmotic laxative. It works by causing water to be retained in the stool. Miralax is a well-known brand of PEG. It increases bowel movements and softens the stool so it’s easier to pass. Experts also recommend lactulose, a human-made sugar that helps with constipation by increasing the number of bowel movements per day.

• Stimulant laxatives: In the short term, adults with CIC can also use bisacodyl or sodium picosulfate (SPS), which are stimulant laxatives that work by stimulating muscles in the intestines. Stimulant laxatives increase the movement of the bowels to help with the passage of stool to relieve constipation.

• Secretagogues: The panel recommends lubiprostone, linaclotide, and plecanatide for patients with CIC who have not been helped by OTC treatments. These medications are used to treat certain digestive disorders and help soften the stool and promote bowel movements.

• 5-HT4 agonists: The panel also suggests that adults with CIC who have not responded to OTC treatments consider prucalopride, a medication that’s used to treat chronic constipation. It works by stimulating the muscles in the intensives to promote bowel movements and relieve constipation as well as facilitate regular bowel movements.

While there are several evidence-based options in the guidelines that can help treat constipation in adults, Chhabra said they are just recommendations. It’s important for patients with symptoms of CIC to talk with their providers or GI specialists to figure out the best option for them, including how much of and how often they should take a recommended medication.

“Guidelines are there to guide us, they don’t dictate how we practice,” said Chhabra. “It’s really about understanding the patient and what works best for them and their preferences.”

Learn More: How Is Constipation Treated?

Natural Ways to Treat Constipation

If you are looking for natural ways to treat constipation, experts say there are many strategies you can try on your own at home:

• Drink plenty of water throughout the day. Aim to have a water intake of up to 64 oz (or 8 cups) every day.

• Increase your physical activity and exercise to help with colon motility.

• Eat foods high in fiber, such as whole wheat bread, bran cereals, and nuts. Other foods that help with constipation include vegetables, prunes, kiwi, avocado, berries, olive and flax seed oils, and legumes.

Learn More: How to Do Abdominal Massage to Relieve Constipation

If you’ve tried strategies like increased fiber and water intake with no relief, Chhabra said to consult with a gastroenterologist. These GI specialists can help people with chronic constipation by going over “how to use over-the-counter laxatives and how long to try them for before determining whether they need something stronger such as prescription-based medications,” she said.

When Is Constipation a Sign of Something Serious?

Constipation can be a sign that something more serious is going on with your health, especially if it isn’t getting better with treatment or it’s getting worse.

“Red flag symptoms” like blood in your stool, unintentional weight loss, a family history of colon cancer, or a sudden change in your bowel patterns are always a reason to talk to your provider.

If you have tried making certain changes to your lifestyle and diet but still have symptoms of constipation, Gupta recommends seeing a provider “to understand the underlying cause, and ensure no other organic etiology behind the constipation.” If OTC medicine doesn’t help or you have side effects, Gupta said that’s also another reason to talk to a specialist.

What This Means For You

The ACG and AGA now recommend magnesium oxide and senna as treatment options for chronic idiopathic constipation. If you still have symptoms of constipation after trying OTC medications and making diet and lifestyle changes, talk with your provider about what other treatments you might be able to try.

Read Next: Can IBS Make You Constipated?