Chronic constipation with associated comorbid conditions: a physician survey on clinical perspectives on its diagnosis and management


  • Rakesh Kumar Department of Internal Medicine, Indraprastha Apollo Hospital, New Delhi, India
  • S. R. Ramakrishnan Department of Medicine, Sri. Ramandra Medical College, Chennai, Tamil Nadu, India
  • Ashwin Kulkarni Department of General Medicine, Ramaiah Medical College, Bengaluru, Karnataka, India



Chronic constipation, Comorbidities, Laxatives, Liquid paraffin, Milk of magnesia, Sodium picosulfate


Background: This survey aimed to investigate physicians’ perspectives on chronic constipation in patients with comorbidities, diagnosis and management of CC, and preferred laxatives used for treating CC in these patients.

Methods: A 32-item, questionnaire-based online survey was conducted among 243 consulting physicians to gather information about CC with comorbidities, diagnosis and management strategies, and preferred laxatives.

Results: The survey showed that 10%-39% of patients experienced CC for >3 months as reported by 61.7% of physicians, with diabetes being the most common comorbid condition. Patient noncompliance (93.8%) was identified as the main factor affecting management outcomes. The most preferred laxative by physicians in adult patients and the elderly was the combination of liquid paraffin+MOM+sodium picosulfate. The primary parameters considered by physicians when choosing a laxative were efficacy and tolerability. The laxative containing liquid paraffin + MOM + sodium picosulfate was reported to be effective for overnight relief by 44.9% of physicians in 60%-89% of patients. Physicians largely opined that side effects such as nausea/vomiting, abdominal cramps/pain, and anal seepage/ incontinence occurred in <1% of patients treated with liquid paraffin+MOM+sodium picosulfate.

Conclusions: Clinical features aid in diagnosing CC and physicians prioritize treatment effectiveness when selecting laxatives. The participating physicians opined that combination laxatives consisting of liquid paraffin+MOM+sodium picosulfate are effective and well-tolerated for managing CC in patients with comorbidities. Hence, it is essential to consider their use for effective management of CC with comorbidities.


Ghoshal UC. Chronic constipation in Rome IV era: The Indian perspective. Indian J Gastroenterol. 2017;36(3): 163-73.

Krogh K, Chiarioni G, Whitehead W. Management of chronic constipation in adults. United Euro Gastroenterol J. 2017;5(4):465-72.

Ghoshal UC, Sachdeva S, Pratap N, Verma A, Karyampudi A, Misra A, et al. Indian consensus on chronic constipation in adults: A joint position statement of the Indian Motility and Functional Diseases Association and the Indian Society of Gastroenterology. Indian J Gastroenterol. 2018; 37(6):526-44.

Mari A, Mahamid M, Amara H, Baker FA, Yaccob A. Chronic constipation in the elderly patient: Updates in evaluation and management. Korean J Fam Med. 2020; 41(3):139-45.

Longstreth GF, Thompson WG, Chey WD, Houghton LA, Mearin F, Spiller RC. Functional bowel disorders. Gastroenterology. 2006;130(5):1480-91.

Drossman DA. The functional gastrointestinal disorders and the Rome III process. Gastroenterology. 2006;130(5):1377-90.

Bagepally RS. Management of chronic constipation in comorbid conditions. Int J Res Med Sci. 2022;10(6): 1382-9.

Enck P, Leinert J, Smid M, Köhler T, Schwille-Kiuntke J. Functional constipation and constipation-predominant irritable bowel syndrome in the general population: Data from the GECCO Study. Gastroenterol Res Pract. 2015;2016:e3186016.

De Giorgio R, Ruggeri E, Stanghellini V, Eusebi LH, Bazzoli F, Chiarioni G. Chronic constipation in the elderly: a primer for the gastroenterologist. BMC Gastroenterol. 2015;15(1):130.

Constipation (Vibandha). Available at: https://www. Accessed on 20 February 2023.

Rao SSC, Rattanakovit K, Patcharatrakul T. Diagnosis and management of chronic constipation in adults. Nat Rev Gastroenterol Hepatol. 2016;13(5):295-305.

Prasad VGM, Abraham P. Management of chronic constipation in patients with diabetes mellitus. Indian J Gastroenterol. 2017;36(1):11-22.

22% of Indian adults suffer from constipation : Abbott “Gut Health Survey”. Available at: https://www. Accessed on 20 February 2023.

Rajput M, Saini SK. Prevalence of constipation among the general population: a community-based survey from India. Gastroenterol Nurs. 2014;37(6):425-9.

Makharia GK, Verma AK, Amarchand R, Goswami A, Singh P, Agnihotri A, et al. Prevalence of irritable bowel syndrome: a community based study from northern India. J Neurogastroenterol Motil. 2011; 17(1):82-7.

Ray G. Evaluation of the symptom of constipation in Indian patients. J Clin Diagn Res. 2016;10(4):OC01-03.

Panigrahi MK, Kar SK, Singh SP, Ghoshal UC. Defecation frequency and stool form in a coastal eastern Indian population. J Neurogastroenterol Motil. 2013;19(3):74-80.

Bellini M, Usai-Satta P, Bove A, Bocchini R, Galeazzi F, Battaglia E, et al. Chronic constipation diagnosis and treatment evaluation: the “CHRO.CO.DI.T.E.” study. BMC Gastroenterol. 2017;17:11.

Bove A, Pucciani F, Bellini M, Battaglia E, Bocchini R, Altomare DF, et al. Consensus statement AIGO/SICCR: Diagnosis and treatment of chronic constipation and obstructed defecation (part I: Diagnosis). World J Gastroenterol. 2012;18(14):1555-64.

Ito H, Ito K, Tanaka M, Hokamura M, Tanaka M, Kusano E, et al. Constipation is a frequent problem associated with vascular complications in patients with type 2 diabetes: A cross-sectional study. Intern Med. 2022;61(9):1309-17.

Piper MS, Saad RJ. Diabetes mellitus and the colon. Curr Treat Options Gastroenterol. 2017;15(4):460-74.

He F, Huang X, Gan H, Dong B. Association of thyroid hormones with chronic constipation in hospitalized elderly patients. Innov Aging. 2017;1(1):970-1.

Shilpi K, Jain AB, Patel D. The study to understand management of constipation and prescription pattern of laxative therapy. Int J Comm Med Public Health 2022; 9(12):4436-43.

Kanzaria H, Dave A, Manani Y, Agravat P. A clinical study on hypothyroidism and its management with Vidanga. Eur J Biomed Pharmaceut Sci. 2017;4:241-4.

Ishiyama Y, Hoshide S, Mizuno H, Kario K. Constipation-induced pressor effects as triggers for cardiovascular events. J Clin Hypertens. 2019;21(3): 421-5.

Sundbøll J, Szépligeti SK, Adelborg K, Szentkúti P, Gregersen H, Sørensen HT. Constipation and risk of cardiovascular diseases: a Danish population-based matched cohort study. BMJ. 2020;10(9):e037080.

Ozturk MH, Kılıc SP. Effective of education on quality of life and constipation severity in patients with primary constipation. Patient Educ Couns. 2019; 102(2):316-23.

Bharucha AE, Lacy BE. Mechanisms, evaluation, and management of chronic constipation. Gastroenterology. 2020;158(5):1232-49.

Portalatin M, Winstead N. Medical management of constipation. Clin Colon Rectal Surg. 2012;25(1):12-9.

Gwee KA, Ghoshal UC, Gonlachanvit S, Chua ASB, Myung SJ, Rajindrajith S, et al. Primary care management of chronic constipation in Asia: The ANMA chronic constipation tool. J Neurogastroenterol Motil. 2013;19(2):149-60.

Wiriyachai T, Tanpowpong P. Pediatricians’ perceptions and practice of the management of constipation in Thailand. Pediatr Int. 2020;62(8):944-9.

Kinnunen O, Salokannel J. Constipation in elderly long-stay patients: its treatment by magnesium hydroxide and bulk-laxative. Ann Clin Res. 1987; 19(5):321-3.

Rafati MR, Karami H, Salehifar E, Karimzadeh A. Clinical efficacy and safety of polyethylene glycol 3350 versus liquid paraffin in the treatment of pediatric functional constipation. DARU. 2011;19(2): 154-8.

McGraw T. Polyethylene glycol 3350 in occasional constipation: A one-week, randomized, placebo-controlled, double-blind trial. World J Gastrointest Pharmacol Ther. 2016;7(2):274-82.

Worona-Dibner L, Vázquez-Frias R, Valdez-Chávez L, Verdiguel-Oyola, M. Efficacy, safety, and acceptability of polyethylene glycol 3350 without electrolytes vs magnesium hydroxide in functional constipation in children from six months to eighteen years of age: A controlled clinical trial. Revista de Gastroenterología de México. 2023;88(2):107-17.

Kienzle-Horn S, Vix JM, Schuijt C, Peil H, Jordan CC, Kamm MA. Comparison of bisacodyl and sodium picosulphate in the treatment of chronic constipation. Curr Med Res Opin. 2007;23(4):691-9.

Zhao Q, Chen YY, Xu DQ, Yue SJ, Fu RJ, Yang J, et al. Action mode of gut motility, fluid and electrolyte transport in chronic constipation. Front Pharmacol. 2021;12:630249.

Kamm MA, Mueller LS, Wald A, Richter E, Swallow R, Gessner U. Oral bisacodyl is effective and well-tolerated in patients with chronic constipation. Clin Gastroenterol Hepatol. 2011;9(7):577-83.

Mueller-Lissner S, Kamm MA, Wald A, Hinkel U, Koehler U, Richter E, et al. Multicenter, 4-week, double-blind, randomized, placebo-controlled trial of sodium picosulfate in patients with chronic constipation. Am J Gastroenterol. 2010;105(4):897-903.

Patankar R, Mishra A. A prospective non-comparative study to assess the effectiveness and safety of combination laxative therapy containing milk of magnesia, liquid paraffin and sodium picosulphate (Cremaffin-Plus®) in the management of constipation in patients with anal fissure/ hemorrhoids/ obstructive defecation syndrome. Int Surg J. 2017;4(12):3899-906.






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