How to treat constipation in 2025: update by Dr. de María
The latest advances in chronic constipation treatment, explained clearly so you can make the best decisions about your digestive health.
Why is it important to talk about constipation in 2025?
Constipation affects up to 20% of the world's population, and although it may seem like a minor problem, it can significantly impact your quality of life. The good news is that in 2025 we have more effective and personalized treatments than ever before.
As a digestive system specialist, I see daily how constipation can affect not only physical health, but also the emotional well-being of my patients. That's why I want to share with you the latest advances based on the most updated medical guidelines.
The leading American medical societies (such as the American Society of Colon and Rectal Surgeons and the American College of Gastroenterology) have recently updated their recommendations, incorporating new medications and more personalized approaches.
What do we really consider constipation?
Warning signs
- • Less than 3 bowel movements per week
- • Very hard or "pellet-like" stools
- • Excessive straining during defecation
- • Feeling of incomplete evacuation
Main types
- • Slow transit: the bowel moves slowly
- • Outlet dysfunction: problem in the rectum
- • Mixed: combination of both
Stepped approach: step by step towards the solution
Modern constipation treatment follows what we call a "stepped approach". This means we start with simple measures and, if they don't work, we move up levels until we find the solution that works for you.
First line: Changes in your daily routine
Smart fiber
Medical guidelines recommend 20-30 grams of fiber per day, but not just any fiber. It's important to combine:
- • Soluble fiber: oats, apples, legumes
- • Insoluble fiber: whole grains, vegetables
Proper hydration
1.5-2 liters of water per day help fiber do its job properly. Without enough water, fiber can worsen constipation.
Important: Up to 80% of people with severe constipation don't improve with fiber alone. If you don't notice changes in 2-4 weeks, it's normal and doesn't mean you're doing something wrong.
Second line: Safe laxatives
If dietary changes aren't enough, we move to osmotic laxatives. These are medications that draw water into the intestine, softening stools naturally.
Polyethylene Glycol (PEG)
Typical dose: 17g daily. Very safe for long-term use.
Magnesium salts
Effective but caution with kidney problems.
Lactulose
Also feeds good gut bacteria.
About stimulant laxatives (like bisacodyl): We reserve these for specific situations or as rescue therapy, as they can cause abdominal pain and dependence if used long-term.
Third line: The new protagonists
This is where 2025 medicine really shines. We have medications that work in very specific and effective ways:
Intestinal secretagogues
These medications make your intestine produce more fluid naturally:
- • Linaclotide: Also relieves abdominal pain
- • Plecanatide: Fewer side effects
- • Lubiprostone: Especially useful in women
Serotonergic agonists
Prucalopride is the best known. It acts on specific receptors that make the intestine move faster. It's already approved in the United States and Europe.
Medications of the future
Elobixibat and others like velusetrag are in advanced development. They work differently and promise to be very effective, although we're still studying their long-term safety.
Special cases: Pelvic floor dysfunction
Some people have constipation because the muscles of the rectum and anus don't function properly. In these cases, medications alone aren't enough.
Biofeedback therapy
It's like "re-educating" the muscles. A specialized physiotherapist teaches you to:
- • Properly relax the anal muscles
- • Coordinate breathing with defecation
- • Improve posture in the bathroom
It's the first recommended option by medical societies for this type of constipation.
Personalized treatment: each person is unique
The most important thing about the 2025 advances is that we no longer treat constipation the same way for everyone. We consider:
Your specific type of constipation
- • Slow transit → prokinetics
- • Outlet dysfunction → biofeedback
- • Mixed → combination of treatments
Your personal preferences
- • Preferred form of presentation
- • Administration schedule
- • Possible side effects
- • Treatment cost
Practical tips for daily life
✅ Do this
- • Establish regular bathroom schedules
- • Use a stool to elevate your legs
- • Exercise regularly (even walking helps)
- • Keep a symptom diary
- • Be patient: changes take 2-4 weeks
❌ Avoid this
- • Using stimulant laxatives daily
- • Increasing fiber too quickly
- • Ignoring the urge to defecate
- • Excessive straining
- • Self-medicating without consulting
When to consult with a specialist?
Not all cases of constipation require a specialist, but you should consult if:
- • Symptoms appeared suddenly
- • There's blood in stools
- • Unexplained weight loss
- • Severe abdominal pain
- • No improvement after 4-6 weeks of treatment
- • Alternating between constipation and diarrhea
- • Family history of colorectal cancer
- • Symptoms interfering with daily life
Conclusion: a promising future
Constipation treatment in 2025 has evolved towards a more personalized, effective and safe approach. We no longer have to settle for generic solutions that work for some but not for all.
Key points you should remember:
- • Stepped approach: We start simple and escalate as needed
- • Osmotic laxatives: Safe and effective for long-term use
- • New medications: More specific with fewer side effects
- • Personalized treatment: Adapted to your specific type of constipation
- • Biofeedback: Excellent option for pelvic floor problems
As a specialist, my goal is to work with you to find the treatment that best fits your particular situation. Constipation doesn't have to be something you have to live with for life.
Scientific references
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