My patient has tried Movicol, fibre and stimulant laxatives. What’s next?

Chronic constipation is a very common presentation in general practice. First line therapy typically includes dietary fibre optimisation, osmotic laxatives (like Movicol) and stimulant laxatives. There is a subset of patients however, who will remain symptomatic despite these measures. 

If constipation persists despite appropriate first-line therapy, several options should be considered : 
  • Pelvic floor dysfunction 
  • Irritable bowel syndrome with constipation (IBS-C)
  • Slow transit constipation
  • Secondary causes such as medications (opioids, anticholinergics), metabolic disorders or neurological disease
At this stage, management may include :
  • Dietitian assessment to optimise diet and ensure adequate fibre intake
  • Pelvic health physiotherapy assessment to exclude pelvic floor dysfunction
  • Prescription medications such as prucalopride
  • Further investigations to assess colonic transit or anorectal function
When should I refer a patient with chronic constipation?

Referral to a gastroenterologist may be appropriate when :

  • Alarm features are present, incl. rectal bleeding, iron deficient anaemia, weight loss, or a change in bowel habit in patients over 40 years.
  • Constipation is refractory to adequate trials of fibre, osmotic and stimulant laxatives
  • Symptoms suggest pelvic floor dysfunction (excessive straining, incomplete evacuation)
  • Diagnostic uncertainty exists
  • Colonoscopy or specialised testing such as anorectal manometry or colonic transit studies may be required. 

Specialist assessment can help clarify the underlying cause of constipation and guide targeted therapy.

If you have any queries, please feel free to contact our team via email.

Reviewed by Dr Nina Parthasarathy on 25 March, 2026.

Disclaimer – This article is for general information and educational purposes only. It is not a substitute for professional advice. Always consult a registered health professional regarding any health-related diagnosis or treatment options.