GoTo Telemed, the nation's leading integrated telehealth ecosystem serving over 10 million patients nationwide, today announced the launch of its dedicated Chronic Constipation Program, a comprehensive virtual care service designed to address the full spectrum of functional and structural gastrointestinal conditions through evidence-based diagnosis, treatment, and ongoing management. Delivered by a network of board-certified gastroenterologists, motility specialists, and pelvic floor therapists, this program provides accessible, expert care for a condition affecting millions of Americans throughout their lives.

Chronic constipation affects an estimated 20% of the U.S. population, with prevalence increasing with age and disproportionately impacting women, older adults, and individuals with certain chronic conditions. Despite its significant impact on quality of life, productivity, and healthcare utilization, many individuals suffer in silence due to embarrassment, limited access to specialists, or normalization of symptoms. GoTo Telemed's program eliminates these barriers by bringing expert digestive health support directly to patients through secure, confidential virtual consultations.

"Constipation is not a topic most people feel comfortable discussing, yet it profoundly affects daily life, causing physical discomfort, emotional distress, and significant impairment in work and social functioning," said a GoTo Telemed spokesperson. "Our Chronic Constipation Program changes this paradigm. We provide patients with direct access to gastroenterologists who understand the complexity of digestive health, offer evidence-based diagnostic and treatment pathways, and deliver continuous support that addresses both symptoms and underlying causes. Through telehealth, we ensure that every individual, regardless of where they live or how uncomfortable they feel discussing their symptoms, receives the expert, compassionate care they deserve."

Comprehensive Clinical Services for Chronic Constipation

GoTo Telemed's Chronic Constipation Program addresses the full range of presentations through specialized clinical pathways informed by the latest evidence and professional guidelines:

Clinical Focus Services and Interventions
Functional Constipation Comprehensive evaluation including detailed bowel history, symptom characterization using Rome IV criteria, and assessment of contributing factors including diet, hydration, physical activity, and medications. Evidence-based treatment planning incorporating fiber optimization, osmotic and stimulant laxatives, and behavioral modifications.
Irritable Bowel Syndrome with Constipation (IBS-C) Specialized assessment for patients whose constipation coexists with abdominal pain and bloating. Treatment pathways including soluble fiber, gut-directed neuromodulators, secretagogues (linaclotide, lubiprostone, plecanatide), and emerging therapies. Integration with behavioral health for stress management when indicated.
Pelvic Floor Dyssynergia Virtual screening for defecatory disorders using validated questionnaires and directed history. Coordination with pelvic floor physical therapists and guidance on biofeedback therapy. Referral pathways for anorectal manometry and balloon expulsion testing when in-person evaluation indicated.
Opioid-Induced Constipation Specialized management for patients on chronic opioid therapy, including evidence-based protocols for peripherally acting mu-opioid receptor antagonists (PAMORAs) such as naloxegol and methylnaltrexone, and combination approaches. Coordination with pain management providers within GoTo Telemed's integrated network.
Slow Transit Constipation Evaluation for colonic dysmotility, including identification of patients who may require advanced testing such as colonic transit studies or wireless motility capsule. Management strategies including high-dose stimulant laxatives, prokinetic agents, and when appropriate, surgical referral.
Constipation-Predominant Disorders in Special Populations Age-appropriate care for pediatric patients, pregnant individuals, older adults, and patients with neurologic conditions (Parkinson's disease, multiple sclerosis, spinal cord injury) affecting bowel function. Tailored treatment plans accounting for physiologic differences and medication safety considerations.
Medication-Refractory Constipation Advanced evaluation for patients failing first- and second-line therapies, including assessment for underlying metabolic, endocrine, or structural causes. Coordination with in-person gastroenterologists for colonoscopy, motility testing, and specialized interventions when indicated.
Evidence-Based Rome IV Diagnostic Criteria

The program is built upon the Rome IV diagnostic framework, the internationally accepted standard for functional gastrointestinal disorders. For functional constipation, diagnostic criteria require that the patient experience at least two of the following for the past three months, with symptom onset at least six months before diagnosis:

Straining during at least 25% of defecations

Lumpy or hard stools (Bristol Stool Scale types 1-2) in at least 25% of defecations

Sensation of incomplete evacuation in at least 25% of defecations

Sensation of anorectal obstruction/blockage in at least 25% of defecations

Manual maneuvers to facilitate at least 25% of defecations (digital evacuation, pelvic floor support)

Fewer than three spontaneous bowel movements per week

For IBS-C, diagnostic criteria require recurrent abdominal pain on average at least one day per week in the last three months, associated with two or more of: related to defecation, associated with change in stool frequency, or associated with change in stool form (appearance), with >25% of bowel movements classified as Bristol Stool Types 1-2 .

Evidence-Based Treatment Algorithms

The program follows a stepwise, evidence-based treatment approach aligned with the latest guidelines from the American Gastroenterological Association (AGA) and the American College of Gastroenterology (ACG):

Treatment Step Interventions
Step 1: Lifestyle and Dietary Modification Adequate fluid intake (1.5-2.0 L/day), gradual increase in dietary fiber (25-30 g/day) with careful attention to soluble fiber (psyllium) which has stronger evidence than insoluble fiber. Regular physical activity (150 minutes/week). Correction of toileting posture with use of footstool to simulate squatting position.
Step 2: Osmotic Laxatives Polyethylene glycol 17 g/day (MiraLax) is the first-line osmotic agent with strong evidence and good tolerability. Lactulose may be used as alternative, though associated with more bloating. Magnesium-containing products may be used but require caution in patients with renal impairment.
Step 3: Stimulant Laxatives Bisacodyl or senna for patients who do not respond to osmotic agents. These agents increase intestinal motility and secretion. Evidence suggests no long-term safety concerns when used appropriately. Suppository forms may be used for rapid relief.
Step 4: Secretagogues For patients with IBS-C or chronic idiopathic constipation (CIC) who fail standard therapy: linaclotide (72-290 mcg/day) increases intestinal fluid secretion and accelerates transit. Lubiprostone (24 mcg BID) activates chloride channels. Plecanatide (3 mg/day) similar mechanism to linaclotide. These agents require prior authorization and have specific prescribing criteria.
Step 5: Serotonin 5-HT4 Receptor Agonists Prucalopride (1-2 mg/day) for women with CIC who have failed at least two previous laxative classes. Improves colonic motility and enhances bowel movement frequency. Requires ECG monitoring and has specific safety considerations.
Step 6: Peripherally Acting Mu-Opioid Receptor Antagonists (PAMORAs) Naloxegol (12.5-25 mg/day) or methylnaltrexone (450 mg/day for patients on stable opioid regimen). These agents specifically target opioid-induced constipation without affecting central analgesia. Require careful patient selection and monitoring.
Step 7: Pelvic Floor Physical Therapy For patients with dyssynergic defecation or pelvic floor dysfunction, referral to specialized pelvic floor physical therapy with biofeedback training is the standard of care. Telehealth-guided biofeedback has shown comparable efficacy to in-person treatment.
Step 8: Advanced and Surgical Options For refractory patients who have failed all medical therapy, referral for sacral nerve stimulation, colonic manometry, or surgical intervention (colectomy with ileorectal anastomosis) is considered. This requires comprehensive pre-operative evaluation including physiological testing.
Specialized Approach for Pelvic Floor Dyssynergia

Pelvic floor dyssynergia (paradoxical contraction or inadequate relaxation of pelvic floor muscles during defecation) affects up to 30-50% of patients with chronic constipation. The program's approach includes:

Virtual Screening: Structured assessment using validated questionnaires (Pelvic Floor Distress Inventory, PFDI) and directed history to identify patients who require specialized evaluation

Telehealth Biofeedback: Evidence-based protocol for home-based biofeedback training using surface EMG sensors and smartphone applications. Studies demonstrate comparable outcomes to in-office biofeedback

Coordination with Pelvic Floor Physical Therapists: Warm handoffs to GoTo Telemed's network of licensed pelvic floor physical therapists for specialized care

Referral for Anorectal Manometry: When indicated, coordination with in-person centers for high-resolution anorectal manometry and balloon expulsion testing to confirm diagnosis and guide treatment

Special Populations and Considerations

The program addresses unique needs across diverse patient populations:

Population Clinical Considerations
Older Adults Age-related changes in intestinal motility, higher prevalence of polypharmacy (including medications causing constipation), increased risk of adverse effects from aggressive laxative use. Special consideration for cognitive impairment, mobility limitations, and caregiver involvement in treatment.
Pregnancy Physiologic constipation common due to progesterone effects, uterine compression, and iron supplementation. Preferred agents: osmotic laxatives (polyethylene glycol, lactulose) are first-line and safe. Stimulant laxatives used sparingly. Avoid castor oil and high-dose mineral oil.
Children Pediatric-specific Rome IV criteria. First-line: dietary modification, toilet training optimization. Polyethylene glycol is the preferred initial therapy. Disimpaction protocols for fecal impaction. Family-centered approach addressing behavioral components.
Patients with Neurologic Disorders Parkinson's disease, multiple sclerosis, spinal cord injury, and other neurologic conditions frequently cause severe constipation. Specialized protocols addressing neurogenic bowel, including scheduled bowel programs, prokinetic agents, and transanal irrigation when appropriate.
Patients with Eating Disorders Constipation is common in patients with restrictive eating disorders due to decreased oral intake, delayed gastric emptying, and medication effects. Treatment must be carefully managed to avoid refeeding syndrome and address underlying psychological factors.
Technology-Enhanced Care Delivery

The program leverages GoTo Telemed's integrated digital health tools to support optimal patient outcomes:

Digital Symptom Tracking: Patients use validated digital tools to track bowel frequency, stool consistency using the Bristol Stool Scale, associated symptoms, and treatment response. This objective data supports accurate diagnosis and enables precise treatment monitoring.

Bowel Diary Integration: The platform includes structured bowel diary templates that patients can complete through the mobile application, with data automatically incorporated into the patient's electronic health record for provider review.

Medication Adherence Monitoring: Automated reminders for prescribed therapies, with tracking of adherence patterns that enable timely intervention when patients miss doses.

Educational Resource Library: Evidence-based patient education materials covering dietary fiber optimization, fluid management, toileting techniques, and medication information, available in multiple formats and languages.

Integration Within GoTo Telemed's Comprehensive Ecosystem

The Chronic Constipation Program operates as a fully integrated component of GoTo Telemed's unified telehealth platform:

Unified Health Record: All consultation documentation, treatment plans, and symptom tracking data are incorporated into the patient's lifetime electronic health record, accessible to all authorized providers across medical and specialty care.

Seamless Care Coordination: When patients present with conditions requiring multidisciplinary care—such as constipation with pelvic floor dysfunction or opioid-induced constipation requiring pain management collaboration—the platform facilitates warm handoffs to appropriate specialists within GoTo Telemed's integrated network.

Prescribing and Pharmacy Integration: Prescriptions for osmotic laxatives, secretagogues, and other medications are transmitted electronically to patient-selected pharmacies, with automated refill management and adherence monitoring. Prior authorization support for specialty medications is provided.

Patient Portal and Mobile Access: Patients access their personalized care plans, educational resources, symptom tracking tools, and secure messaging through GoTo Telemed's patient portal and mobile application, ensuring continuous engagement between scheduled visits.

Clinical Decision Support: Built-in clinical pathways guide providers through Rome IV diagnostic criteria, stepwise treatment algorithms, and appropriate referral criteria, ensuring consistent, high-quality care across the provider network.

Addressing Critical Gaps in Digestive Health Care

The Chronic Constipation Program directly confronts persistent barriers to gastroenterology care:

Geographic Access: Specialist shortages in rural and underserved communities leave millions without access to gastroenterologists. Wait times for gastroenterology appointments in many markets exceed three to six months, during which patients suffer with unmanaged symptoms. Telehealth eliminates these geographic and temporal barriers.

Stigma Reduction: Many individuals hesitate to seek help for bowel symptoms due to embarrassment or normalization of symptoms. Virtual consultations from home offer enhanced privacy, reducing stigma and increasing treatment engagement.

Care Fragmentation: Patients with chronic constipation often receive fragmented care from primary care providers, gynecologists, and other specialists without coordinated expertise. GoTo Telemed's integrated approach ensures all care is guided by gastroenterology expertise.

Continuity of Care: Chronic constipation requires ongoing management with treatment adjustments over time. The program provides continuous, longitudinal support rather than episodic visits.

Diagnostic Accuracy: Many patients are misdiagnosed with refractory constipation when underlying conditions such as pelvic floor dyssynergia, colonic dysmotility, or structural abnormalities remain unidentified. Structured evaluation with Rome IV criteria and appropriate testing ensures accurate diagnosis.

Health Disparities: Individuals from marginalized communities face higher rates of chronic constipation due to dietary factors, stress, and limited healthcare access. The program's culturally competent providers and telehealth accessibility help address these disparities.

A Transformative Opportunity for Gastroenterology Providers

For gastroenterologists and motility specialists, GoTo Telemed's Chronic Constipation Program offers a meaningful practice opportunity:

Focus on Specialized, High-Impact Work: Providers apply their expertise to a population with profound needs for evidence-based digestive care, experiencing the satisfaction of improving quality of life, reducing pain, and preventing complications.

Flexible Practice Model: Clinicians maintain complete autonomy over their schedules, practicing as little or as much as desired while serving a nationwide population of patients seeking digestive health expertise.

Complete Practice Support: GoTo Telemed provides full malpractice insurance coverage, comprehensive billing and coding support for gastroenterology services, and immediate access to a growing population of patients seeking chronic constipation management.

Professional Independence: Providers build their practice within GoTo Telemed's supportive ecosystem while maintaining clinical autonomy and professional decision-making authority.

No Administrative Burden: The platform handles all credentialing, scheduling, billing, and documentation, allowing clinicians to focus entirely on clinical care and patient relationships.

Regulatory Compliance and Quality Assurance

The Chronic Constipation Program operates within GoTo Telemed's rigorous compliance framework:

State-Specific Licensure Management: Verification of active, unrestricted licenses in all states where care is delivered, with support for interstate licensure compacts

Gastroenterology Clinical Guidelines: Adherence to AGA, ACG, and Rome IV evidence-based guidelines for chronic constipation management

Controlled Substance Compliance: Rigorous adherence to DEA regulations for controlled substances where applicable (PAMORAs, certain stimulant laxatives)

Quality Monitoring: Ongoing peer review, competency assessments, and patient outcome tracking ensuring maintenance of highest care standards

HIPAA-Compliant Infrastructure: Enterprise-grade encryption, access controls, and regular third-party security audits ensuring complete protection of patient health information

Availability and Partnerships

GoTo Telemed's Chronic Constipation Program is available immediately to patients nationwide through the GoTo Telemed platform and mobile application. Patients may enroll directly or be referred by their primary care provider, gynecologist, or other health professional.

Gastroenterologists, motility specialists, and pelvic floor physical therapists interested in joining GoTo Telemed's provider network are invited to apply through the company's credentialing portal.

GoTo Telemed is actively forming strategic partnerships with:

Gastroenterology practices seeking to expand virtual service offerings

Primary care networks managing digestive health across large populations

Pelvic floor physical therapy practices

Pain management programs for patients with opioid-induced constipation

Health plans and Medicare Advantage organizations

Skilled nursing facilities and senior living communities

Community health centers serving underserved populations

Media Contact:
GoTo Telemed Media Relations
[email protected]
(660) 628-1660
www.gototelemed.com