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.
New entrants into the market may feel some intimidation by the large number of companies already supplying constipation treatments. The underlying situation suggests there’s no need to worry. The reason is that constipation remains an “idiopathic” disease, meaning that there is no clear indicator of its cause. As a result, most people don’t know a priori the most effective treatment and must try a few before hitting upon one that works.
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.
The market for nutrient supplements is dominated by players such as Metamucil. The nutrients are derived from natural foods or grains that have lots of fiber. To take as an example, Metamucil comes in a powdered drink form which contains ground psyllium seeds that are extremely rich in fiber. People who take it simply mix it with fluids and drink it for a powerful daily dose.
Herbal agents have come to mean senna, which is a shrubby, bushy plant of Middle Eastern origins. In the past, cascara and aloe have also been used as natural laxative herbs, but the FDA banned such substances for safety reasons. Now, senna is the primary herb for treating constipation. Senna can be purchased in capsule form or tea form. The herb has been used for thousands of years and is thought to be mostly safe, but as with any medication agents consultation with a physician is recommended before dosing.
By far the most active segment of the constipation treatment market is the over-the-counter (OTC) and prescription medication category. The medicines are all quite different in their mode of action, individual efficacy and cost. It’s likely that a patient will have to try out a few before finding one that works well. Some examples of these include stimulant laxatives and lubricant laxatives.
The last class of medications is the one to which Amitiza belongs, new molecular therapies that are designed specifically for constipation. Amitiza for example has been approved for both IBS-C and chronic constipation. It acts by binding to a cellular molecule known as a ClC2 channel. There are a number of similar therapies being developed. Some like Amitiza promise to open up new vistas by treating constipation in entirely different ways from traditional medications.