[Therapeutic options of chronic constipation]

Chronic constipation is a widespread disease affecting up to 25 percent of the population in western countries. The symptoms associated with constipation may lead to a heavy burden and a decrease in quality of life. The therapy of chronic constipation is based upon its type and severity. Patients with normal transit may benefit from lifestyle measures including dietetic advice. However, almost none of these measures has been validated in a controlled trial. Bulk forming laxatives such as psyllium seeds and probiotics have a moderate evidence (Grade B). In certain cases, the use of osmotic laxatives, e. g. polyethylene glycol solutions (Grade A), is necessary. Tegaserod, a selective agonist of the serotonine subtype 4 (5-HT(4)), has a good evidence to treat constipation (Grade A). Patients with slow-transit constipation (transit-time over 72 hours) are dependent on osmotic (polyethylene glycol solutions, Grade A) and stimulant laxatives (bisacodyl, Grade C). Patients who suffer from defecatory disorders (outlet constipation) should be treated with bulk forming laxatives (Grade B) together with suppositories (e. g. CO(2)-suppositories) and enemas.