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Mechanisms, Evaluation, and Management of Chronic Constipation
Adil E Bharucha1, Brian E Lacy2
1Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
Gastroenterology
|January 17, 2020
Summary
Chronic constipation affects 15% globally, presenting diverse symptoms and causes. Effective management involves dietary changes, laxatives, and targeted therapies based on patient evaluation.
Area of Science:
- Gastroenterology
- Colorectal Surgery
- Ambulatory Medicine
Background:
- Chronic constipation is a prevalent gastrointestinal diagnosis worldwide (15%).
- Symptoms are diverse, including straining, incomplete evacuation, and reduced stool frequency.
- It can be primary (transit or defecatory disorders) or secondary to medications/anatomic issues.
Purpose of the Study:
- To review the mechanisms, evaluation, and management of chronic constipation.
- To highlight the importance of patient history and physical examination.
- To discuss diagnostic testing and individualized treatment strategies.
Main Methods:
- Review of pathogenic mechanisms including colonic sensorimotor disturbances and pelvic floor dysfunction.
- Evaluation strategies such as anorectal and colonic transit tests (manometry, barostat).
- Management approaches ranging from dietary fiber and laxatives to surgical options like colectomy.
Main Results:
- Management should be guided by efficacy and cost, starting with conservative measures.
- Diagnostic tests help identify specific disorders like defecatory dysfunction or colonic dysmotility.
- Biofeedback therapy is effective for defecatory disorders; colectomy may be needed for refractory slow-transit constipation.
Conclusions:
- Individualized treatment plans are crucial for managing chronic constipation.
- Further research is needed to compare different laxative efficacies.
- Comprehensive evaluation is key for refractory cases.
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