Non-drug therapies for the management of chronic constipation in adults

Non-drug therapies for the management of chronic constipation in adults

Review by Brigitte Collins of The CapaCiTY Report

As we are aware chronic constipation affects a high number of the population, who tend to suffer for many years. The ‘CapaCiTY’ study has been investigating treatments appropriate for this group, which has been recently published. The study comprised of three randomised controlled trials (RCTs): 1 Habit training compared with habit training with direct visual feedback.  2. Low volume compared to high volume initiated transanal irrigation (TAI). 3. Laparoscopic ventral mesh rectopexy. 

My focus has been drawn to section 2 comparing low volume irrigation to high volume irrigation in chronic constipation. Recruitment was planned for 300, 65 were randomised with outcome assessments completed at 3 months (n=48), 6 months (n=44) and 12 months (n=34). Despite numbers being low, I believe the trial still has some valuable findings.  

There is an awareness in clinical practice, which is also supported by the ‘Decision Guide’ (Emmanuel et al, 2019), that high volume irrigation would generally be recommended for patients with chronic constipation. It was therefore not surprising that high volume demonstrated improvement in patient’s outcome measures. Interestingly, it was also pleasing to see that low volume irrigation also had clinical benefit with a reduction of scores in the same outcome measures. The paper also concurs that many of the treatment responses improved over time, as well as, seeing a 76% survival of the treatment at 1-year. Therefore, implying a continued significant effect. 

I really like the fact that the publication also shows the impact on quality of life with many suggesting they had a freedom from the ongoing discomfort of chronic constipation and how TAI was preferable to laxatives. At the same time patients did not feel their bowels were ‘normal’, although, TAI brought them back to their own sense of ‘normal’. 

What this RCT demonstrates is that TAI can be a beneficial bowel management option in chronic constipation. So good to see that TAI can improve such debilitating symptoms.