Gastroenterologists Recommend 2 New Treatments for Chronic Constipation

May 01, 2023

Alyssa Hui is a St. Louis-based health and science news writer. She was the 2020 recipient of the Midwest Broadcast Journalists Association Jack Shelley Award.

Nick Blackmer is a librarian, fact-checker, and researcher with more than 20 years’ experience in consumer-oriented health and wellness content.

Photo Illustration by Lecia Landis for Verywell Health; Getty Images

The American College of Gastroenterology (ACG) and the American Gastroenterological Association (AGA) recently published new clinical practice guidelines for using medication to treat chronic idiopathic constipation (CIC) in adults. The effort is meant to give healthcare providers clear and practical suggestions for effectively managing the common condition.

The updated guidelines include 10 evidence-based recommendations for the treatment of CIC. Two treatments—magnesium oxide and senna—are included in the recommendations for the first time.

Chronic idiopathic constipation (CIC) is a common condition that affects 8%–12% of the United States population. People with CIC can have symptoms like infrequent bowel movements, the feeling of having incomplete bowel movements, and bowel movements that are hard to pass, but unlike other kinds of constipation, the cause of CIC is not known.

Here's what experts want you to know about managing CIC, including when to talk to your provider about medications that may help.

Magnesium oxide is a type of magnesium supplement that can be used to relieve GI symptoms like heartburn and acid indigestion.

Ekta Gupta, MD, assistant professor of medicine in the Department of Gastroenterology and Hepatology at the Johns Hopkins University School of Medicine, told Verywell that magnesium oxide can also be used as an osmotic laxative to soften stools.

"The non-absorbed magnesium creates an osmotic gradient, which draws more water in the colon, making it softer and easier to pass," said Gupta.

Senna comes from the herb Senna alexandrina and acts as a stimulant laxative, making it different from magnesium oxide.

Megan Gerber, RD, LDN, a functional and integrative dietitian/nutritionist and the founder of Grounded Nourishment, told Verywell that senna works by actively triggering contractions in the muscles of the gut to stimulate bowel movements.

Gerber said that both options are available over-the-counter (OTC) in capsule, pill, or tablet forms. Magnesium oxide also comes in a powder, and senna can be made into tea.

According to Gupta, the ACG and AGA cited two studies to support the updated recommendation that includes magnesium oxide and senna as treatment options for CIC.

For example, studies have shown that patients who used magnesium oxide had complete and more spontaneous bowel movements per week, and also reported improved quality of life. For senna, research has shown it may increase spontaneous and complete bowel movements and also improve patients’ quality of life.

Despite the findings, Gupta said the research has important limitations to think about—for example, the trials were only four weeks long and did not look at the long-term effects of these treatments.

"Given the short duration of the study, it is a conditional recommendation with very low certainty of evidence," said Gupta, adding that the "long-term use data is also not available" for these treatments.

What does that mean for providers and patients? While there is some research to back up the inclusion of magnesium oxide and senna as recommended CIC treatments, we still need more research—preferably with more people and longer timeframes—to know for sure how safe and effective they are.

While there are limitations to the available research, other experts say that magnesium oxide and senna made the list of recommended treatments for CIC because they did show effectiveness in the studies that have been done.

"We’re still learning a lot about constipation and what causes it other than dietary changes that can be modified," Natasha Chhabra, MD, a gastroenterologist at Gastroenterology Associates of New Jersey, told Verywell. "This is still something that's being studied on how it can be tested and improved upon, [but] all of these medications work on improving motility."

Chhabra added that another potential reason why both treatments are being recommended now is that they are considered more accessible and affordable for patients because they’re sold OTC and are relatively low-cost.

"The cost of managing constipation can be very high," she said. "Although there are prescription medications available for constipation—some of which are mentioned in the guidelines—a lot of these are not available in generic form yet, so they may be at a higher cost depending on the person's insurance plan."

The medical costs of managing CIC range from $2,000 to $7,500 dollars per patient per year.

Besides magnesium oxide and senna, the ACG and AGA also list other nonpharmacological therapies for CIC, including OTC and prescription medications that providers and patients can consider.

While there are several evidence-based options in the guidelines that can help treat constipation in adults, Chhabra said they are just recommendations. It's important for patients with symptoms of CIC to talk with their providers or GI specialists to figure out the best option for them, including how much of and how often they should take a recommended medication.

"Guidelines are there to guide us, they don't dictate how we practice," said Chhabra. "It's really about understanding the patient and what works best for them and their preferences."

If you are looking for natural ways to treat constipation, experts say there are many strategies you can try on your own at home:

If you’ve tried strategies like increased fiber and water intake with no relief, Chhabra said to consult with a gastroenterologist. These GI specialists can help people with chronic constipation by going over "how to use over-the-counter laxatives and how long to try them for before determining whether they need something stronger such as prescription-based medications," she said.

Constipation can be a sign that something more serious is going on with your health, especially if it isn't getting better with treatment or it's getting worse.

"Red flag symptoms" like blood in your stool, unintentional weight loss, a family history of colon cancer, or a sudden change in your bowel patterns are always a reason to talk to your provider.

If you have tried making certain changes to your lifestyle and diet but still have symptoms of constipation, Gupta recommends seeing a provider "to understand the underlying cause, and ensure no other organic etiology behind the constipation." If OTC medicine doesn't help or you have side effects, Gupta said that's also another reason to talk to a specialist.

The ACG and AGA now recommend magnesium oxide and senna as treatment options for chronic idiopathic constipation. If you still have symptoms of constipation after trying OTC medications and making diet and lifestyle changes, talk with your provider about what other treatments you might be able to try.

American Gastroenterological Association. ACG and AGA guideline on chronic constipation management is first to recommend supplements magnesium oxide and senna as evidence-based treatments.

Chang L, Chey WD, Imdad A, et al. American Gastroenterological Association-American College of Gastroenterology clinical practice guideline: pharmacological management of chronic idiopathic constipation. Am J Gastroenterol. 2023;118(6):936-954. doi:10.14309/ajg.0000000000002227

MedlinePlus. Magnesium oxide.

NHS. Laxatives.

MedlinePlus. Senna.

National Institute of Diabetes and Digestive and Kidney Diseases. Treatment for constipation.

By Alyssa HuiAlyssa Hui is a St. Louis-based health and science news writer. She was the 2020 recipient of the Midwest Broadcast Journalists Association Jack Shelley Award.