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Clinical management of intractable constipation

M Camilleri1, W G Thompson, J W Fleshman

  • 1Gastroenterology Research Unit, Mayo Clinic, Rochester, MN 55905.

Annals of Internal Medicine
|October 1, 1994
PubMed
Summary

Intractable constipation management involves identifying underlying causes and tailoring treatments. Behavioral modification and biofeedback show excellent long-term success, with surgery reserved for select cases.

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Area of Science:

  • Gastroenterology
  • Colorectal Surgery
  • Digestive System Disorders

Background:

  • Constipation is a common condition, often manageable with lifestyle changes.
  • A subset of patients presents with intractable constipation requiring specialized medical and surgical evaluation.
  • Understanding the etiology is crucial for effective treatment of chronic constipation.

Purpose of the Study:

  • To review the current management strategies for intractable constipation.
  • To identify diagnostic criteria and therapeutic interventions for complex constipation cases.
  • To evaluate the efficacy of behavioral and surgical approaches.

Main Methods:

  • Literature review of original articles and reviews from 1965-1993 via MEDLINE.
  • Analysis of keywords including constipation, colonic inertia, pelvic floor dysfunction, biofeedback, and colectomy.
  • Consideration of clinical symposium feedback.

Main Results:

  • Most constipation cases respond to increased dietary fiber and lifestyle adjustments.
  • In patients with intractable constipation, only 29% had a definable abnormality.
  • Abnormal transit identification aids in selecting patients for further investigation of colonic inertia or pelvic floor dysfunction.

Conclusions:

  • An algorithmic approach effectively selects patients for behavioral modification and biofeedback, achieving over 75% success.
  • Subtotal colectomy with ileorectostomy is indicated and effective for a minority with slow transit constipation unresponsive to medical treatment.