Management of Constipation: A Narrative Review of Evolving Strategies and Methodological Challenges

The review systematically integrates multi-level management strategies for constipation, from lifestyle and pharmacological to behavioral and surgical options, noting that traditional laxatives remain the mainstay of treatment. Compared with prior literature focused on single therapies, this review presents a panoramic view of the contemporary treatment landscape and discusses new drug mechanisms alongside classic laxatives. Narrative review based on synthesis of existing literature, without original trial data or quantitative pooled results.

Newer agents such as prosecretory drugs, serotonergic agonists, and bile acid modulators have expanded therapeutic possibilities with targeted mechanisms and improved tolerability. Places therapies added over the past decade into a unified framework, clarifying their positioning relative to traditional laxatives in terms of mechanism and tolerability. Descriptive synthesis; specific drug names, doses, or effect sizes are not provided in the text.

Non-pharmacological approaches including biofeedback and neuromodulation provide effective alternatives in selected patients, particularly for pelvic floor dysfunction. Highlights the value of non-pharmacological interventions in selected populations, complementing traditional drug-centered narratives. Narrative synthesis without specific trial sample sizes or effect estimates.

Substantial methodological variability exists in clinical trials regarding diagnostic criteria, endpoints, and follow-up durations, limiting generalizability and necessitating a more standardized framework for defining outcomes and assessing long-term efficacy. Explicitly identifies methodological heterogeneity as a core challenge for evidence synthesis in this field, rather than merely listing treatment options. Observational synthesis of existing trial characteristics, without systematic search or bias assessment.

This article is intended for clinical readers seeking a rapid overview of contemporary constipation management strategies, including lifestyle and dietary modifications, pharmacological therapies, behavioral interventions, and surgical options for refractory cases; its individualized treatment principles can be applied in clinical decision-making that integrates symptom severity, underlying pathophysiology, patient preference, and resource availability. The newer agents and non-pharmacological approaches summarized primarily target functional constipation and specific subgroups such as patients with pelvic floor dysfunction and refractory constipation.

Readers should still note: the review does not provide specific drug names, doses, effect sizes, or trial sample sizes, so relative efficacy of therapies cannot be assessed from it; the specific manifestations of methodological heterogeneity and details of a standardized framework are not elaborated; artificial intelligence for microbiome modulation is mentioned only as a future direction without concrete study results; because the current reading scope is summary-level, details in figures and references may affect further judgment of evidence strength.