Constipation May Lead to Other Problems

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Though the role of constipation in diverticular disease and colon cancer remains unclear, case-control studies -- which compare one group of people with a health condition to another group without it -- have shown a significant association between constipation and hemorrhoids. Interventional studies, which have involved dietary changes and medicinal therapies to minimize constipation, also have suggested a cause-and-effect relationship.

At least an association has been shown between constipation and other conditions, too. Studies of people with rectal prolapse, in which the rectum becomes stretched and protrudes from the anus, suggest such a relationship. More than 50 percent of people with anal fissures, which are small splits or tears in anal tissue, also have constipation. And fecal incontinence, the second most common cause for nursing home admissions, often occurs along with constipation, the researchers noted.

There also appears to be a causal relationship between constipation and urologic disorders.

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Despite such connections, the number of medications approved by the U.S. Food and Drug Administration to treat chronic constipation is limited, according to a review in a supplement to the Journal of Managed Care Pharmacy.

One of the newer medications, Amitiza (lubiprostone), is the only FDA-approved medication for the treatment of adults with chronic constipation for which there is no known cause.

"Lubiprostone appears to be very effective; however, a relatively high percentage suffer from nausea when they take the drug on an empty stomach," said James C. Eoff III, executive associate dean and professor of clinical pharmacy at the University of Tennessee College of Pharmacy in Memphis. "For the ones who take it with food, the percent effectiveness ratings are very good."

But there are new options in the pipeline. One is a drug called linaclotide, the first compound in a new class of laxative agents. "This would be a very effective alternative to treatment of chronic constipation," Eoff noted.

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