Refractory Constipation: What is the Clinician to Do?

Area of Science:

• Gastroenterology
• Colorectal Surgery
• Functional Gastrointestinal Disorders

Background:

• Chronic constipation is prevalent, yet patient perception and treatment satisfaction vary significantly.
• Many patients with constipation, particularly those with overlapping symptoms like abdominal pain or IBS, require specialized care beyond standard laxatives.
• Refractory constipation presents a significant clinical challenge, necessitating advanced diagnostic and therapeutic strategies.

Purpose of the Study:

• To outline a physiological assessment framework for patients with refractory constipation.
• To explore diverse treatment options, including non-laxative approaches and surgical interventions, for different constipation subtypes.
• To emphasize a comprehensive, biopsychosocial model for managing functional gastrointestinal diseases.

Main Methods:

• Review of physiological assessment techniques for refractory constipation.
• Exploration of treatment strategies for slow transit, rectal evacuation disorders, and normal transit constipation.
• Discussion of non-laxative therapies, neuromodulators, and surgical options like colectomy and cecostomy.

Main Results:

• A structured approach to assessing refractory constipation is proposed, differentiating between physiological subtypes.
• Various treatment modalities, from neuromodulators to surgical interventions, are discussed for managing complex cases.
• The review highlights the importance of considering the biopsychosocial model in functional gastrointestinal disorders.

Conclusions:

• Effective management of refractory constipation necessitates a tailored physiological assessment and consideration of advanced therapies.
• Surgical interventions, including colectomy and cecostomy, represent viable options for carefully selected patients with severe slow-transit constipation.
• A comprehensive approach integrating physiological, psychological, and surgical aspects is crucial for optimizing patient outcomes.