No disagreement from me. Posting only so the question does not look ignored.
0 likes 3mo
Practice · Side effects · continued
Constipation management, with a dietitian's contribution posts 61–89
This is a continuation of a long topic, addressed by post number rather than by page. Start at post 1 · go to the accepted answer.
My experience of constipation management contradicts the reply above. I am posting it as a data point rather than as a refutation, because one person's experience is exactly that.
3 likes 3mo
d.szymanski, post #39: Constipation management: I would want to see the raw numbers rather than the summary before agreeing. Summaries lose exactly the information that would settle this. Go to post
This follows post #62 rather than contradicting it.
The published rates come from populations that were titrated on a defined schedule with clinical supervision. Rates from a forum are not comparable and are biased by who chooses to post.
The uncertainty is in the assumption, not in the calculation.
Worth separating two things that post #62 runs together.
Reading back through the constipation management threads from last year, the same three questions come up every time and only one of them has ever been answered properly. That seems like a documentation gap rather than a knowledge gap.
33 likes 3mo
r.novak, post #12: The relationship between symptom burden and outcome is not what people assume. Feeling worse is not evidence of a larger effect and feeling nothing is not evidence of an inactive preparation. I would put the burden of proof on the interesting explanation, not the dull one. Go to post
The relationship between symptom burden and outcome is not what people assume. Feeling worse is not evidence of a larger effect and feeling nothing is not evidence of an inactive preparation.
The short version is the first sentence; the rest is why.
i.amankwah, post #34: The bit of constipation management that nobody enjoys is that the answer changes depending on what you are trying to decide with it. Say what the decision is and the thread will converge. Go to post
Constipation: common, manageable, and frequently under-reported because it is not dramatic. Increasing fibre and fluid intake helps. Over-the-counter management is usually effective. This is worth addressing proactively rather than waiting for it to worsen.
I would want to see it done twice before believing it once.
Post #64 and I disagree about the size of the effect, not about the direction.
The published rates come from populations that were titrated on a defined schedule with clinical supervision. Rates from a forum are not comparable and are biased by who chooses to post.
I am describing what is, rather than arguing for what should be.
25 likes 2mo
Post #66 is the version of this I will quote in future. One addition.
Where I have landed on constipation management, having got it wrong once in public: the direction is clear, the magnitude is not, and anyone quoting a precise magnitude has borrowed it from somewhere that did not measure it.
3 likes 2mo
Good question, well framed, and I would like to see it answered properly.
11 likes 2mo
PWendelboe, post #66: The relationship between symptom burden and outcome is not what people assume. Feeling worse is not evidence of a larger effect and feeling nothing is not evidence of an inactive preparation. The short version is the first sentence; the rest is why. Go to post
Distinguishing three things in the constipation management discussion that keep getting used interchangeably: the observation, the proposed mechanism, and the recommendation that gets attached to both.
i.ilunga, post #51: Adding the boring version of constipation management, because the interesting version keeps getting posted and the boring one is usually right. Check the ordinary explanations, in order, and stop when one of them accounts for what you are seeing. Most of the time the second one does. Go to post
Post #71 answers the question as asked. The question underneath it is different.
The relationship between symptom burden and outcome is not what people assume. Feeling worse is not evidence of a larger effect and feeling nothing is not evidence of an inactive preparation.
If anyone can point at the primary source I would be grateful.
g.valckenaere, post #3: Summarising the constipation management thread so far, since it is long and the answer is buried: the first reply has the method, the fourth has the correction to it, and the rest is people agreeing at length. Go to post
Everything in post #71 holds. The case it does not cover is the one I have.
The published rates come from populations that were titrated on a defined schedule with clinical supervision. Rates from a forum are not comparable and are biased by who chooses to post.
That is all the detail I have. Someone else will have more.
ambient_draft, post #62: My experience of constipation management contradicts the reply above. I am posting it as a data point rather than as a refutation, because one person's experience is exactly that. Go to post
Narrowing post #75, because the general version has more than one answer.
Constipation is reported at least as often as nausea and is discussed a fraction as much. Fluid, fibre and movement are the boring answers and they are the ones that work.
The published rates come from populations that were titrated on a defined schedule with clinical supervision. Rates from a forum are not comparable and are biased by who chooses to post.
1 like 2mo
Adding thanks rather than a view. I do not have a view worth the space.
0 likes 1mo
r.weiss, post #57: I would put moderate confidence on the mainstream reading of constipation management and no more. That is not scepticism for its own sake; it is where the sourcing actually stops. Go to post
I had written a reply contradicting post #75 and deleted it. Here is what survived.
Constipation is reported at least as often as nausea and is discussed a fraction as much. Fluid, fibre and movement are the boring answers and they are the ones that work.
Collapsed as off-topic by two members at trust level 3 or above
The relationship between symptom burden and outcome is not what people assume. Feeling worse is not evidence of a larger effect and feeling nothing is not evidence of an inactive preparation.
That is my reading. Someone else read the same page differently and was reasonable.
s.karlsen_rph, post #71: Distinguishing three things in the constipation management discussion that keep getting used interchangeably: the observation, the proposed mechanism, and the recommendation that gets attached to both. Go to post
What I would want before treating constipation management as settled: the method, the sample, and whether anyone tried to find the opposite result. Two of the three are usually missing.
policy_reader, post #9: Genuine question rather than a rhetorical one: has anyone here actually observed constipation management, as opposed to read about it? The thread is long and I cannot tell. Go to post
I read post #79 twice before replying, because I had assumed the opposite.
The reason constipation management keeps being re-asked is that the answer is conditional and people quote it without the condition. It is not that the answer is unknown.
The published rates come from populations that were titrated on a defined schedule with clinical supervision. Rates from a forum are not comparable and are biased by who chooses to post.
0 likes 1mo
r.szabo, post #83: Adding a note of thanks rather than an opinion. I did not know most of that. Go to post
Narrowing post #84, because the general version has more than one answer.
Constipation: common, manageable, and frequently under-reported because it is not dramatic. Increasing fibre and fluid intake helps. Over-the-counter management is usually effective. This is worth addressing proactively rather than waiting for it to worsen.
I have deliberately not rounded that, because the rounding is where the argument starts.
Everything in post #82 holds. The case it does not cover is the one I have.
The published rates come from populations that were titrated on a defined schedule with clinical supervision. Rates from a forum are not comparable and are biased by who chooses to post.
That is the version I would defend. It is not the version I started with.
19 likes 27d
Collapsed as off-topic by two members at trust level 3 or above
Marking my uncertainty on constipation management explicitly. I am confident about the direction, much less confident about the size, and not confident at all that it generalises past the case in the first post.
The arithmetic in post #87 is right; the assumption feeding it is the part to check.
The relationship between symptom burden and outcome is not what people assume. Feeling worse is not evidence of a larger effect and feeling nothing is not evidence of an inactive preparation.
The rule of thumb is fine; the edge cases are where it earns its keep.
0 likes 21d
This topic was referenced in
- [2026 update] Distinguishing expected GI effects from something that needs urgent attentionPractice › Side effects · 14 replies
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