For ordinary chronic constipation, polyethylene glycol (PEG), psyllium, and several prescription medicines have the strongest support. For pelvic-floor dysfunction, biofeedback can be more effective than adding laxatives.
Below are 70 treatments and management approaches, with stronger options first within each group. They are not equally effective, and some apply only to a specific diagnosis. This list concerns adults; references are at the end.
Seek urgent assessment for constipation with severe abdominal pain, vomiting, marked distension, or inability to pass gas. Rectal bleeding, anemia, unexplained weight loss, or a persistent new change also warrant evaluation. [6,10]
Best-Supported Medicines and Fiber
Evidence labels below reflect guideline recommendations for chronic idiopathic constipation, unless otherwise specified. [1–3]
Polyethylene Glycol 3350—PEG, MiraLAX
Strong evidence; often the best initial medication. A usual adult starting dose is 17 g daily.
Psyllium Husk
Best-supported fiber supplement; introduce gradually with adequate fluid.
Bisacodyl Tablets
Strong guideline support for short-term or rescue treatment.
Sodium Picosulfate
Strong support for short-term or rescue use; availability varies.
Linaclotide—Linzess
Strong support after inadequate response to OTC treatment; also treats IBS with constipation.
Plecanatide—Trulance
Strong support after OTC failure; also used for IBS with constipation.
Prucalopride—Motegrity
Strong support after OTC failure; stimulates intestinal motility.
Lubiprostone—Amitiza
Conditional recommendation; increases intestinal fluid.
Senna
Conditional recommendation; effective stimulant laxative.
Magnesium Oxide
Conditional recommendation; avoid in significant kidney impairment because magnesium can accumulate.
Lactulose
Conditional recommendation; useful when other OTC options fail or are unsuitable. Gas is common.
Tenapanor—Ibsrela
Evidence-supported prescription treatment specifically for IBS with constipation.
Other Oral Laxatives and Combination Strategies
These are alternatives or escalation strategies; evidence is generally less robust than for PEG or the strongly recommended prescriptions. [1,4,5]
Magnesium Hydroxide—Milk of Magnesia
Osmotic laxative; kidney precautions apply.
Lactitol
Osmotic prescription laxative for adult chronic idiopathic constipation.
Sorbitol Solution
Osmotic alternative; may cause gas and cramping.
Methylcellulose
Bulk-forming fiber; less direct efficacy evidence than psyllium.
Calcium Polycarbophil
Bulk-forming agent; evidence is limited.
Wheat Bran
May help some patients, but can worsen bloating.
PEG Plus an Intermittent Stimulant
Useful when PEG alone provides incomplete relief.
A Prescription Agent Plus an Osmotic Laxative
Clinician-directed option for refractory symptoms.
Food and Nutrition Approaches
Kiwifruit, prunes, and psyllium have direct clinical-trial evidence. General dietary measures are most useful when intake is inadequate. [6–9]
Green Kiwifruit
Two daily were effective in a comparative trial.
Prunes
Trials have used approximately 100 g daily; smaller starting amounts may improve tolerance.
Prune Juice
A placebo-controlled trial found improvement in hard stools and constipation symptoms.
Rye Bread
Some trial evidence for improved bowel function; may increase gas.
High-Mineral Water Containing Magnesium and Sulfate
Some evidence of benefit; check mineral content and kidney suitability.
Correcting a Low-Fiber Diet
Increase fiber-rich foods toward an individualized target, commonly about 22–34 g/day.
Correcting Dehydration
Helpful when dehydrated; excessive extra water is not a reliable treatment in an already hydrated person.
Gradual Fiber Titration
Improves tolerability and helps maintain an effective intake.
Adequate Food Intake in People Who Undereat
Low intake can reduce stool volume and meal-triggered bowel activity.
A Selected Probiotic With Constipation-Specific Trial Evidence
Benefits are strain-specific and inconsistent; lower priority than established laxatives.
Toileting, Movement, and Pelvic-Floor Treatments
Some are supportive habits; others are specialized treatments. Components of biofeedback are listed separately because they address different evacuation problems. [5,6,10–12]
Regular Physical Activity
Particularly useful when inactivity contributes.
Scheduled Toileting After Breakfast
Uses the meal-related gastrocolic response.
Responding Promptly to the Urge to Defecate
Reduces habitual stool withholding.
A Footstool During Toileting
Can improve positioning; benefit varies.
Relaxed, Time-Limited Toileting Without Prolonged Forceful Straining
Instrument-Guided Pelvic-Floor Biofeedback
First-line treatment for confirmed dyssynergic defecation.
Coordinated Abdominal-Push and Anal-Relaxation Training
A central biofeedback component.
Rectal Sensory Retraining
A biofeedback component for selected patients with impaired rectal sensation.
Abdominal Massage
Trial-supported adjunct; evidence is smaller than for standard medicines.
Electroacupuncture
Sham-controlled trial evidence exists, but it is not a routine first-line treatment.
Rectal Treatments and Fecal Impaction
These address stool already in the rectum or substantial stool accumulation. Suspected obstruction must be excluded before a cleanout. [4,5,13]
Glycerin Suppositories
Occasional rectal rescue.
Bisacodyl Suppositories
Rectal stimulant for rescue or structured bowel programs.
Mineral-Oil Retention Enemas
Can soften impacted rectal stool.
Sodium-Citrate Micro-Enemas
Small-volume rectal rescue; formulations vary by country.
Clinician-Performed Manual Disimpaction
For hard stool that cannot otherwise be evacuated.
Clinician-Directed Oral PEG Disimpaction
For appropriate patients after excluding obstruction.
Transanal Irrigation
A trained, supervised option for selected refractory or neurogenic bowel cases.
Opioid-Related Constipation
These treatments target a particular mechanism and are not interchangeable with treatment for ordinary constipation. [14]
Reducing Opioid Exposure When Feasible
Through a prescriber-guided pain-management plan.
Naldemedine—Symproic
Strong guideline recommendation for laxative-refractory opioid-induced constipation.
Naloxegol—Movantik
Strong guideline recommendation for laxative-refractory opioid-induced constipation.
Methylnaltrexone—Relistor
Conditional guideline recommendation when laxatives are inadequate.
Removing Medication Triggers and Treating Underlying Disease
These help when the identified factor actually causes constipation; they are not treatments for everyone. Medication changes should be coordinated with the prescriber. [5,6,10,15]
Changing Constipating Oral Iron Therapy
Adjust dose, schedule, formulation, or route when appropriate.
Reducing Anticholinergic Medication Burden
Includes some bladder medicines, antihistamines, and antidepressants.
Replacing a Constipating Calcium-Channel Blocker
Verapamil is a common example.
Reducing Unnecessary Calcium Supplements or Constipating Antacids
Treating Confirmed Hypothyroidism
Thyroid hormone is inappropriate for constipation with normal thyroid function.
Correcting Hypercalcemia
Including treatment of its underlying cause.
Correcting Hypokalemia
Low potassium can impair intestinal motility.
Treating Confirmed Celiac Disease
A gluten-free diet may help when celiac disease presents with constipation.
Specialist Options for Difficult or Refractory Cases
These require diagnosis-based selection. Procedures and surgery come after adequate medical and pelvic-floor treatment. [5,10,16,17]
Pyridostigmine, Off-Label
Limited evidence, particularly in selected patients with diabetes or autonomic dysfunction.
A Prescription Vibrating Capsule
A sham-controlled phase 3 trial showed benefit in chronic constipation.
Botulinum Toxin for a Nonrelaxing Puborectalis
Selected outlet dysfunction; evidence is limited and benefit may be temporary.
Repair of a Functionally Significant Rectocele
After treating coexisting pelvic-floor dysfunction.
Repair of Symptomatic Rectal Prolapse
When prolapse causes impaired evacuation.
Selected Surgery for Obstructing Rectal Intussusception
Only after unsuccessful conservative treatment.
Colectomy With Ileorectal Anastomosis
Reserved for carefully documented, refractory slow-transit constipation without ongoing defecatory dysfunction.
Antegrade Continence Enemas Through an Appendicostomy or Cecostomy
Specialized bowel-emptying option.
A Diverting Ileostomy or Other Ostomy
Last-resort treatment in highly selected severe cases.
An Individualized Neurogenic Bowel Program
Combines timing, oral or rectal agents, and trained evacuation techniques.
Maintenance Treatment After Disimpaction
Regular stool-softening treatment and follow-up help prevent recurrent impaction.
Two Commonly Misunderstood Options
Docusate has weak evidence and is generally a lower priority than PEG. Sodium-phosphate enemas can cause serious kidney and electrolyte injury, especially with excess dosing, dehydration, kidney disease, or older age. [1,18]
References
- Chang L, Chey WD, Imdad A, et al. American Gastroenterological Association–American College of Gastroenterology Clinical Practice Guideline: Pharmacological Management of Chronic Idiopathic Constipation. Gastroenterology. 2023;164(7):1086–1106. doi:10.1053/j.gastro.2023.03.214.
- Schoenfeld P. AGA–ACG Clinical Practice Guideline on Chronic Idiopathic Constipation Treatments: Parsing Benefits and Risks. Evidence-Based GI. American College of Gastroenterology. June 2023.
- Chang L, Sultan S, Lembo A, Verne GN, Smalley W, Heidelbaugh JJ. AGA Clinical Practice Guideline on the Pharmacological Management of Irritable Bowel Syndrome With Constipation. Gastroenterology. 2022;163(1):118–136. doi:10.1053/j.gastro.2022.04.016.
- Portalatin M, Winstead N. Medical management of constipation. Clinics in Colon and Rectal Surgery. 2012;25(1):12–19. doi:10.1055/s-0032-1301754.
- Staller K, Neshatian L, Lembo A, Bharucha AE. AGA Clinical Practice Update on Evaluation and Management of Refractory Constipation: Expert Review. Clinical Gastroenterology and Hepatology. 2026;24(2):296–305. doi:10.1016/j.cgh.2025.09.031.
- National Institute of Diabetes and Digestive and Kidney Diseases. Treatment for Constipation; Eating, Diet, & Nutrition for Constipation. National Institutes of Health.
- Dimidi E, van der Schoot A, Barrett K, Farmer AD, Lomer MC, Scott SM, Whelan K. British Dietetic Association Guidelines for the Dietary Management of Chronic Constipation in Adults. Journal of Human Nutrition and Dietetics. 2025;38(5). doi:10.1111/jhn.70133.
- Chey SW, Chey WD, Jackson K, Eswaran S. Exploratory comparative effectiveness trial of green kiwifruit, psyllium, or prunes in US patients with chronic constipation. American Journal of Gastroenterology. 2021;116(6):1304–1312.
- Koyama T, Nagata N, Nishiura K, et al. Prune juice containing sorbitol, pectin, and polyphenol ameliorates subjective complaints and hard feces while normalizing stool in chronic constipation: a randomized placebo-controlled trial. American Journal of Gastroenterology. 2022;117:1714–1717.
- Alavi K, Thorsen AJ, Fang SH, et al. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Evaluation and Management of Chronic Constipation. Diseases of the Colon & Rectum. 2024;67(10):1244–1257. doi:10.1097/DCR.0000000000003430.
- Abdominal Massage in Functional Chronic Constipation: A Randomized Placebo-Controlled Trial. Physical Therapy. 2022;102(7). doi:10.1093/ptj/pzac058.
- Liu Z, Yan S, Wu J, et al. Acupuncture for chronic severe functional constipation: a randomized trial. Annals of Internal Medicine. 2016;165(11):761–769. doi:10.7326/M15-3118.
- Fecal Impaction. In: StatPearls. Treasure Island, FL: StatPearls Publishing. Available through NCBI Bookshelf.
- American Gastroenterological Association. Medical Management of Opioid-Induced Constipation. Clinical guideline, published 2018.
- National Institute of Diabetes and Digestive and Kidney Diseases. Symptoms & Causes of Constipation. National Institutes of Health.
- Bharucha AE, Low PA, Camilleri M, et al. A randomised controlled study of the effect of cholinesterase inhibition on colon function in patients with diabetes mellitus and constipation. Gut. 2013;62(5):708–715. doi:10.1136/gutjnl-2012-302483.
- Rao SSC, Quigley EMM, Chey WD, Sharma A, Lembo AJ. Randomized placebo-controlled phase 3 trial of vibrating capsule for chronic constipation. Gastroenterology. 2023;164(7):1202–1210.e6.
- US Food and Drug Administration. FDA warns of possible harm from exceeding recommended dose of over-the-counter sodium phosphate products to treat constipation. Drug Safety Communication.