In surveys conducted by academic researchers and pharmaceutical companies, it has been revealed that constipation is a condition that’s estimated to afflict anywhere from 5 to 15% of the general population. The high incidence suggests not only that there exists a very large market for people interested in constipation treatments, but also that in response to the demand a plethora of agents have been developed to combat constipation.
The fact that there are many supplements and medications targeted toward the constipation patient might discourage new entrants into the market, however the truth is that there are fairly few (if any) universally effective treatments. Instead, the product market is fragmented into sectors, none of which can provide complete relief to the average sufferer. The market for constipation treatments can continue to support novel agents, as long as they provide new benefits over existing treatments.
The current state of affairs in the constipation treatment market is that products can be categorized into 4 divisions. The four can be summarized as the following: over-the-counter medications or ones requiring prescriptions, nutritional supplements available to most consumers without prescription, natural herbal agents not in the purview of the FDA, and finally a novel but handful of molecular therapeutics that target root biological causes of constipation.
Supplemental agents encompass brand names like Metamucil which are derived from natural sources of high fiber usually. An example of a natural source are psyllium husks, which are the seed husks of the plantago plant. They are ground into powdered form and mixed with liquids for a high fiber drink. Supplemental agents are usually safe but still need to be taken with plenty of water for the right bulk effect.
By and large, herbal supplements are synonymous with senna, which are rich in sennosides, a class of compounds that stimulates the intestine. The constipation treatment market used to be much more crowded with other herbal supplements like aloe and cascara, but the FDA has since then cracked down on new entrants to the field because of safety concerns. Some manufacturers still produce aloe-based herbal supplements in concordance with the law.
Over-the-counter laxative agents make up the largest proportion of constipation treatments. Laxative agents are diverse, operating through different physiological labels such as “stimulant”, “lubricant” or “bulk”. The stimulant laxatives actually cause greater muscle movement in the large intestine that helps push food along. The lubricant laxative reduce water uptake in the gut which helps keep the food retain fluid and eases its movement.
Finally, a new generation of medicines known as “molecular” medicines await approval from the FDA. The first of these, amitiza, directly fires a protein receptor in sensor cells of the intestine which cause fluid secretion and spontaneous bowel movement. General laxatives operate through unclear mechanisms usually with empirical bases, whereas amitiza and other agents were designed for a specific mechanism. The result is a more targeted medication, and one that has achieved elusive acceptance by the FDA for treating chronic constipation.