Constipation in adults: diagnosis and management.

Area of Science:

• Gastroenterology
• Digestive Health
• Clinical Medicine

Background:

• Constipation is highly prevalent, particularly in individuals over 60, affecting an estimated 35 million in the USA.
• A significant gap exists between patient-reported symptoms (bloating, straining) and physician criteria (infrequent stools).
• Accurate diagnosis and management are often delayed due to differing symptom interpretations.

Purpose of the Study:

• To outline the diagnostic and management strategies for constipation.
• To highlight the importance of understanding patient-reported symptoms alongside clinical criteria.
• To review current and emerging treatment options for constipation.

Main Methods:

• Initial evaluation involves a detailed patient history (bowel habits, diet, activity, medications) and physical examination.
• Diagnostic testing is generally not recommended initially unless alarm signs are present.
• Further investigations like anorectal manometry are considered for refractory cases.

Main Results:

• First-line management focuses on lifestyle modifications: increased physical activity, high-fiber diet, adequate hydration, and specific bowel management techniques.
• Biofeedback therapy is effective for dyssynergic defecation.
• Pharmacologic therapies range from stool softeners to agents promoting intestinal transit.

Conclusions:

• Comprehensive management of constipation requires addressing underlying causes, implementing effective bowel habits, and judicious use of laxatives.
• Personalized treatment strategies can significantly alleviate symptoms and enhance patients' quality of life.
• Understanding the discrepancy between patient and physician symptom perception is crucial for effective care.