Dr. Brooks Cash from the National Naval Medical Center in Bethesda, Maryland has published a detailed review on Medscape.

There are some surprising conclusions regarding common treatments, including fluids, dietary fiber, physical activity, education, enema, and biofeedback.


  • Adequate fluid intake might promote general health, but decreased fluid intake does not appear to be a major cause of chronic constipation.
  • No studies show that increased fluid intake improves bowel function.


  • Most Americans consume 5-10 grams daily (20-35 grams are recommended).
  • The American Gastroenterological Association recommends a gradual increase in fiber intake in either dietary or standardized supplement form as a first-line approach to treat chronic constipation.
  • People without an underlying motility disorder improve or become symptom free.
  • There is no strong or consistent evidence for the effectiveness of treating constipation with dietary fiber in institution-dwelling older adults.

Physical activity

  • In elderly people living at home, in hospitals, or nursing homes, exercise is not effective stand-alone therapy for chronic constipation.
  • Exercise may help improve bowel function as part of a broad rehabilitation program.


  • There is some evidence that having a bowel movement may be a conditioned response for which some individuals can be trained.


  • Claims of benefit remain unproven.

Biofeedback Therapy

  • Effective for people with abnormal contraction or failure to relax the pelvic floor muscles during attempts to defecate.
  • Requires good interaction between the therapist and the patient.

11/15/07 20:29 JR

Hi, I’m JR

John Russo, Jr., PharmD, is president of The MedCom Resource, Inc. Previously, he was senior vice president of medical communications at www.Vicus.com, a complementary and alternative medicine website.