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When fiber is not enough: current thinking on constipation management.

Dorothy B Doughty¹

¹Emory University Wound Ostomy Continence Nursing Education Center, Atlanta, GA 30322, USA. ddoughty@emory.edu

Ostomy/Wound Management

|December 20, 2002

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Chronic constipation often requires more than fiber and fluids. Management strategies vary by type, including biofeedback for pelvic floor dysfunction and laxatives for slow transit constipation.

Area of Science:

Gastroenterology
Digestive Health

Background:

Constipation is a prevalent gastrointestinal disorder.
Many patients do not respond to basic interventions like increased fiber and fluid intake.
Primary constipation, without a clear cause, is common and presents in distinct patterns.

Purpose of the Study:

To summarize current understanding of constipation etiology, pathology, and classification.
To present a stepwise approach for evaluating and managing chronic constipation.
To outline treatment strategies based on constipation subtypes.

Main Methods:

Review of current understanding of constipation.
Classification of primary constipation into three patterns: constipation-predominant irritable bowel syndrome, slow transit constipation, and pelvic floor dysfunction.

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Stepwise evaluation including history, physical examination, and laboratory studies.

Main Results:

Dyssynergic defecation (pelvic floor dysfunction) often responds to biofeedback and pelvic muscle re-education.
Constipation-predominant irritable bowel syndrome management involves diet, fiber, and self-care education.
Slow transit constipation may benefit from fiber and activity, often requiring laxative therapy (bulk and osmotic agents first-line, stimulants for PRN use).

Conclusions:

Effective constipation management requires identifying the underlying pattern.
Treatment should be tailored to specific constipation types for optimal outcomes.
A systematic approach to evaluation and management improves patient care for chronic constipation.