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Chronic constipation: new insights, better outcomes?

Lawrence R Schiller¹

¹Baylor University Medical Center, Dallas, TX, USA; Texas A&M University College of Medicine, Dallas, TX, USA.

The Lancet. Gastroenterology & Hepatology

|October 15, 2019

Summary

Constipation affects many adults, often presenting as straining rather than infrequent bowel movements. Proper diagnosis requires excluding rectal outlet dysfunction before considering prescription treatments.

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Area of Science:

Gastroenterology
Internal Medicine

Background:

Constipation is a prevalent symptom affecting 11-20% of adults annually.
Patient perception of constipation often centers on straining, differing from the physician's focus on defecation frequency.

Purpose of the Study:

To highlight the discrepancy between physician and patient definitions of constipation.
To emphasize the importance of excluding rectal outlet dysfunction in constipation management.
To guide physicians in assessing and optimizing patient self-treatment strategies.

Main Methods:

Review of common diagnostic criteria and patient-reported symptoms for constipation.
Emphasis on physical examination to identify rectal outlet dysfunction.
Assessment of previous self-management attempts and prescription medication strategies.

Main Results:

A significant portion of patients experiencing constipation report excessive straining.
Rectal outlet dysfunction is present in approximately 25% of idiopathic constipation cases.
Effective management requires a tailored approach beyond simple laxative use.

Conclusions:

Constipation diagnosis and management should consider both physician and patient perspectives.
Excluding rectal outlet dysfunction is crucial for appropriate treatment selection.
Physicians play a key role in optimizing constipation management by assessing prior treatments and strategically using available therapies.