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• Posted January 7, 2026

Surgery Should Be Last Resort For Chronic Constipation, Guidelines Say

Surgery should be a last resort for people suffering from severe, chronic constipation, according to new guidelines from the American Gastroenterological Association (AGA).

Colectomy – surgical removal of part or all of the colon – is often considered for people with constipation that doesn’t respond to treatment, also known as refractory constipation.

But this approach carries significant health risks and does not always lead to symptom relief, researchers warn today in the journal Clinical Gastroenterology and Hepatology.

“For people who have struggled for years, surgery can sound like a permanent fix — especially after many failed medications,” said lead researcher Dr. Kyle Staller, director of the Gastrointestinal Motility Laboratory at Massachusetts General Hospital in Boston.

“Doctors may consider surgery when tests show that the colon itself moves stool extremely slowly and other treatments truly haven’t worked,” he continued. “That said, surgery is not appropriate for most people with constipation, and it carries real risks. Some people continue to have symptoms like bloating, abdominal pain or difficulty with bowel control even after surgery.”

About 8% to 12% of Americans suffer from chronic constipation, researchers said in background notes.

“Most people have constipation at some point, and for many it improves with simple steps — diet changes, fiber, fluids or over-the-counter laxatives,” Staller said. “Refractory constipation is different. It means constipation that doesn’t improve despite trying appropriate treatments over time, including prescription medications and, when needed, biofeedback/pelvic floor therapy.”

What makes refractory constipation different isn’t just how uncomfortable it is, he added.

"It’s that it signals an underlying problem with how the bowels or pelvic muscles are working, rather than something that can be fixed with a single medication or dietary tweak,” Staller said.

But a colectomy is associated with a high rate of complications, including bowel obstruction, persistent abdominal pain, bloating, recurrent constipation and continued reliance on laxatives, researchers said.

In the new guideline, the AGA lists a number of steps that should be taken before surgery is considered.

For example, doctors should first rule out the possibility that a person’s chronic constipation isn’t being caused by side effects from medications, a neurologic disorder or a mental health problem, the guidelines say.

Opioids, antipsychotics and iron supplements are known to contribute to constipation, Staller said. Anticholinergic drugs used to treat bladder issues, allergies and mood disorders also are linked to constipation, as they block the action of a neurotransmitter involved in involuntary muscle movement.

Likewise, neurologic conditions like Parkinson’s disease or multiple sclerosis and mental health problems like eating disorders, depression and anxiety can influence a person’s risk of constipation, Staller said.

“Identifying and addressing these contributors is often a critical step before labeling constipation as 'refractory,’ ” Staller said.

Because a person’s mental health can contribute to constipation, patients should undergo a pre-operative psychological evaluation as an important part of the decision-making process, the guidelines say.

Patients also should try out all U.S. Food and Drug Administration-approved drugs and over-the-counter remedies, and even off-label drugs that have been shown to help with constipation, the guidelines say.

One potential off-label drug is pyridostigmine, which is used to treat the nerve disease myasthenia gravis, the guidelines say. The drug has been shown to improve constipation in people with neuropathy and diabetes.

Doctors also should have patients undergo colonic transit testing or defecography – procedures that track colon function and bowel activity.

As a final step, the guidelines recommend that candidates undergo a temporary colostomy, in which waste is diverted from the colon into a bag outside the body. This procedure can be reversed, and might help determine whether a person is likely to benefit from permanent removal of their colon.

Ultimately, the guidelines emphasize that surgery should be considered on a careful case-by-case basis.

“The best outcomes come from careful preparation and shared decision-making,” Staller said. “When surgery is truly needed, people do best when expectations are realistic and when care is coordinated between gastroenterologists, surgeons and mental health professionals.”

Staller said people can personally lower their risk of chronic constipation by:

• Reviewing medications regularly with a clinician and adjusting those that worsen constipation.

• Eating regular meals, rather than chronically restricting food intake.

• Staying physically active, which helps bowel movements.

• Responding to the urge to have a bowel movement, rather than delaying it.

• Seeking medical evaluation if symptoms persist, instead of escalating treatments on their own.

People also should “understand that ‘normal’ bowel habits vary widely — daily bowel movements aren’t required for good health,” Staller said.

“Perhaps most importantly, recognizing that constipation is often a chronic condition that requires thoughtful, long-term management can help prevent frustration and reduce the risk of symptoms becoming severe or refractory,” Staller said.

More information

The National Institutes of Health has more on constipation.

SOURCES: American Gastroenterological Association, news release, Jan. 7, 2026; Dr. Kyle Staller, director, Gastrointestinal Motility Laboratory at Massachusetts General Hospital, Boston