In the January 2005 issue of theAmerican Journal of Gastroenterology,Stefan Müller-Lissner, MD, challengedmany of the long-held beliefs regardingchronic constipation. For example, fiberdecreases transit time and stool mass inhealthy individuals, but little evidence suggeststhat lack of dietary fiber causeschronic constipation. Fiber may benefit asubgroup of patients with less severesymptoms, but it may exacerbate alreadysevere symptoms. Fluid intake may beuseful for treating constipation in patientswho are dehydrated; otherwise, minimalevidence shows that increasing fluidingestion can have a clinically relevantimpact.
Increased physical activity does notappear to significantly ameliorate constipationin otherwise healthy young adults,but increased activity may be beneficial,along with other measures, for treatingconstipation in the elderly. Stimulant laxativesat normal doses do not appear to beharmful to the colon, and no data indicatethat their use is a risk factor for colorectalcancer. Lastly, there is no physiologicbasis supporting concern about dependenceon or addiction to stimulant laxativesin otherwise healthy patients; however,long-term use is not recommended, andpatients with comorbid psychiatric disordersare more likely to misuse them.