Physician understanding and preferences on the current management and treatment approaches for chronic constipation: a cross-sectional survey-based study


  • Kaushik Chatterjee Department of Gastroenterology, Peerless Hospital, Kolkata, West Bengal, India
  • Mandovi Nath 2Department of Medical Affairs, Abbott India Ltd., Mumbai, Maharashtra, India



Chronic constipation, Laxatives, Soluble fibers


Background: Chronic constipation is a prevalent gastrointestinal (GI) motility disorder. To date, there is a lack of real-world evidence on the current treatment approaches and patterns in the management of chronic constipation in India.

Methods: We administered a cross-sectional, physical and digital-based survey between May 2021 and November 2021 to experienced gastroenterologists from different zones of India whose practices encompass direct care of patients with chronic constipation. The questionnaire included 30 close-ended questions on qualitative aspects of constipation management, with specific focus on physicians’ experience with efficacy, tolerability and compliance of Duphalac bulk, a combination of soluble fibers and lactulose. Responses of survey participants were summarized and analyzed using descriptive statistics. All analyses were performed using SPSS 25.0.

Results: The survey was completed by 195 respondents, of which, 81.5% of physicians preferred osmotic laxatives plus fibers for the management of chronic constipation. Soluble fibers are the preferred choice of physicians (84.6%) over insoluble fibers and lactulose plus soluble fibers was the most preferred in the management of constipation symptoms. The efficacy, tolerability and compliance of Duphalac® bulk were found to be highly satisfactory.

Conclusions: In this survey, key practice-relevant information on the current treatment approaches related to the management of chronic constipation from Indian were garnered. The use of soluble fibers was found to be preferred over insoluble fibers, and the clinical profile of a combination formulation of soluble fibers and lactulose was found to be extremely satisfactory among the survey population.


Camilleri M, Ford AC, Mawe GM, Dinning PG, Rao SS, Chey WD, et al. Chronic constipation. Nat Rev Dis Primers. 2017;3:17095.

Ghoshal UC. Chronic constipation in Rome IV era: the indian perspective. Indian J Gastroenterol. 2017;36(3):163-73.

Basilisco G, Coletta M. Chronic constipation: a critical review. Dig Liver Dis. 2013;45(11):886-93.

Suares NC, Ford AC. Prevalence of, and risk factors for, chronic idiopathic constipation in the community: systematic review and meta-analysis. Am J Gastroenterol. 2011;106(9):1582-91.

Moezi P, Salehi A, Molavi H, Poustchi H, Gandomkar A, Imanieh MH, et al. Prevalence of chronic constipation and its associated factors in pars COHORT study: a study of 9000 adults in Southern Iran. Middle East J Dig Dis. 2018;10(2):75-83.

Neri L, Basilisco G, Corazziari E, Stanghellini V, Bassotti G, Bellini M, et al. Constipation severity is associated with productivity losses and healthcare utilization in patients with chronic constipation. United European Gastroenterol J. 2014;2(2):138-47.

Wald A, Scarpignato C, Kamm MA, Mueller-Lissner S, Helfrich I, Schuijt C, et al. The burden of constipation on quality of life: results of a multinational survey. Aliment Pharmacol Ther. 2007;26(2):227-36.

Everhart JE, Ruhl CE. Burden of digestive diseases in the United States part II: lower gastrointestinal diseases. Gastroenterology. 2009;136(3):741-54.

Gálvez C, Garrigues V, Ortiz V, Ponce M, Nos P, Ponce J. Healthcare seeking for constipation: a population-based survey in the Mediterranean area of Spain. Aliment Pharmacol Ther. 2006;24(2):421-8.

Panigrahi MK, Kar SK, Singh SP, Ghoshal UC. Defecation frequency and stool form in a coastal eastern Indian population. J Neurogastroenterol Motil. 2013;19(3):374-80.

Kasthuri A, Hegde SK, Joseph MA, Rao DP, Gomez G, Sahu A. Prevalence of constipation among elderly in a rural area of Bangalore. Indian J Res Rep Med Sci. 2013;3:1.

Rajput M, Saini SK. Prevalence of constipation among the general population: a community-based survey from India. Gastroenterol Nurs. 2014;37(6):425-9.

Longstreth GF, Thompson WG, Chey WD, Houghton LA, Mearin F, Spiller RC. Functional bowel disorders. Gastroenterology. 2006;130(5):1480-91.

Drossman DA. The functional gastrointestinal disorders and the Rome III process. Gastroenterology. 2006;130(5):1377-90.

American College of Gastroenterology Chronic Constipation Task Force. An evidence-based approach to the management of chronic constipation in North America. Am J Gastroenterol. 2005;100(1):1-4.

Tandon RK, Prasad N, Gupta MC, Tandon BN. Stool weights and transit time in North Indians. J Assoc Physicians India. 1976;24(12):807-10.

Singh N, Makharia GK, Joshi YK. Dietary survey and total dietary fiber intake in patients with irritable bowel syndrome attending a tertiary referral hospital. Indian J Gastroenterol. 2008;27(2):66-70.

Babu J, Kumar S, Babu P, Prasad JH, Ghoshal UC. Frequency of lactose malabsorption among healthy southern and northern Indian populations by genetic analysis and lactose hydrogen breath and tolerance tests. Am J Clin Nutr. 2010;91(1):140-6.

Mearin F, Lacy BE, Chang L, Chey WD, Lembo AJ, Simren M, et al. Bowel disorders. Gastroenterology. 2016:6(16):222-5.

Gwee KA, Lu CL, Ghoshal UC. Epidemiology of irritable bowel syndrome in Asia: something old, something new, something borrowed. J Gastroenterol Hepatol. 2009;24(10):1601-7.

Wald A, Scarpignato C, Kamm MA, Mueller-Lissner S, Helfrich I, Schuijt C, et al. The burden of constipation on quality of life: results of a multinational survey. Aliment Pharmacol Ther. 2007;26(2):227-36.

Tomita T, Kazumori K, Baba K, Zhao X, Chen Y, Miwa H. Impact of chronic constipation on health-related quality of life and work productivity in Japan. J Gastroenterol Hepatol. 2021;36(6):1529-37.

Ghoshal UC, Sachdeva S, Pratap N. Indian consensus on chronic constipation in adults: A joint position statement of the Indian Motility and Functional Diseases Association and the Indian Society of Gastroenterology. Indian J Gastroenterol. 2018;37(6):526-44.

Serra J, Mascort-Roca J, Marzo-Castillejo M, Aros SD, Ferrándiz Santos J, Rubio E, et al. Clinical practice guidelines for the management of constipation in adults. Part 2: diagnosis and treatment. Gastroenterol Hepatol. 2017;40(4):303-16.

Portalatin M, Winstead N. Medical management of constipation. Clin Colon Rectal Surg. 2012;25(1):12-9.

Johanson JF, Kralstein J. Chronic constipation: a survey of the patient perspective. Aliment Pharmacol Ther. 2007;25(5):599-608.

Paré P, Bridges R, Champion MC, Ganguli SC, Gray JR, Irvine EJ, et al. Recommendations on chronic constipation (including constipation associated with irritable bowel syndrome) treatment. Can J Gastroenterol. 2007;21:3-22.

Camilleri M, Bharucha AE. Behavioural and new pharmacological treatments for constipation: getting the balance right. Gut. 2010;59(9):1288-96.

Wahab P, Yusoff D, Kadir A, Ali SH, Yeh L. Prevalence, symptoms, and associated factors of chronic constipation among older adults in North-East of Peninsular Malaysia. Clin Nurs Res. 2022;31(2):348-55.

Dinning PG, Hunt L, Lubowski DZ, Kalantar JS, Cook IJ, Jones MP. The impact of laxative use upon symptoms in patients with proven slow transit constipation. BMC Gastroenterol. 2011;11:121.

Suares NC, Ford AC. Systematic review: the effects of fibre in the management of chronic idiopathic constipation. Aliment Pharmacol Ther. 2011;33(8):895-901.

Mineo H, Hashizume Y, Hanaki Y, Murata K, Maeda H, Onaga T, et al. Chemical specificity of short-chain fatty acids in stimulating insulin and glucagon secretion in sheep. Am J Physiol. 1994;267:234-41.

Anderson JW, Gilinsky NH, Deakins DA, Smith SF, O'Neal DS, Dillon DW, et al. Lipid responses of hypercholesterolemic men to oat-bran and wheat-bran intake. Am J Clin Nutr. 1991;54(4):678-83.

Hengst C, Ptok S, Roessler A, Fechner A, Jahreis G. Effects of polydextrose supplementation on different faecal parameters in healthy volunteers. Int J Food Sci Nutr. 2009;60(5):96-105.

Shimada M, Nagano N, Goto S, Ito K, Tsutsui T, Ando T, et al. Effect of polydextrose intake on constipation in Japanese dialysis patients: A triple-blind, randomized, controlled trial. J Nutr Sci Vitaminol (Tokyo). 2015;61:345-53.

Yen CH, Kuo YW, Tseng YH, Lee MC, Chen HL. Beneficial effects of fructo-oligosaccharides supplementation on fecal bifidobacteria and index of peroxidation status in constipated nursing-home residents--a placebo-controlled, diet-controlled trial. Nutrition. 2011;27:323-8.

Chen HL, Lu YH, Lin JJ, Ko LY. Effects of isomalto-oligosaccharides on bowel functions and indicators of nutritional status in constipated elderly men. J Am Coll Nutr. 2001;20:44-9.




How to Cite

Chatterjee, K., & Nath, M. (2022). Physician understanding and preferences on the current management and treatment approaches for chronic constipation: a cross-sectional survey-based study. International Journal of Research in Medical Sciences, 10(11), 2434–2442.



Original Research Articles