The surgical management of constipation

Area of Science:

• Gastroenterology
• Colorectal Surgery
• Physiology

Background:

• Constipation is a common condition with diverse etiologies.
• Accurate patient selection is vital for successful surgical intervention.
• The anal physiology laboratory provides essential diagnostic tools.

Purpose of the Study:

• To highlight the importance of anal physiology in diagnosing constipation.
• To outline appropriate treatment strategies based on constipation type.
• To improve outcomes of surgical constipation treatment.

Main Methods:

• Evaluation of anal physiology to determine the cause of constipation.
• Categorization of constipation into slow transit constipation and pelvic floor outlet obstruction.
• Assessment of combined conditions like colonic inertia and internal intussusception.

Main Results:

• Surgical treatment for slow transit constipation involves total abdominal colectomy with ileorectal anastomosis.
• Pelvic floor outlet obstruction, a functional disorder, is best treated with muscle/sensory retraining.
• Combined conditions require initial correction of pelvic floor outlet obstruction followed by colonic inertia treatment.

Conclusions:

• Anal physiology evaluation is indispensable for guiding constipation treatment.
• Tailored treatment based on diagnosis significantly reduces surgical failure rates.
• Prioritizing pelvic floor retraining for functional disorders optimizes patient outcomes.