According to surveyors from both academia and the pharmaceutical industry, the general population experiences a 10% incidence rate of constipation. Such a high incidence means that there is a large market for medications and supplements targeted toward constipation, and that the number of players in the market that supply these treatment agents is correspondingly large.
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.
At the moment, the market for therapeutics is divisible into four categories. These include herbal supplements that are usually not regulated by the FDA unless there are exceptional circumstances, medical laxatives that can be prescribed or bought over counter, nutritional supplements available in health or fitness stores, and a new class of molecular therapies which act in novel ways unless traditional therapies.
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.
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.
The largest class of laxatives in the market of constipation treatments is the one that includes OTC agents found in pharmacies and apothecaries. Such laxatives come in various brand names, have various active ingredients and act in different ways. Patients might consider trying two or three classes before settling on any one. For example, lubricant laxatives help reduce water uptake by coating food in an oily cover. If a patient doesn’t respond to it, he or she might try a stimulant laxative that causes the gastrointestinal tract to contract more often for speeding up movement of contents.
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.
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