Chronic Constipation

Adil E. Bharucha, Arnold Wald

Research output: Contribution to journalReview article

8 Citations (Scopus)

Abstract

Constipation is a common symptom that may be primary (idiopathic or functional) or associated with a number of disorders or medications. Although most constipation is self-managed by patients, 22% seek health care, mostly to primary care physicians (>50%) and gastroenterologists (14%), resulting in large expenditures for diagnostic testing and treatments. There is strong evidence that stimulant and osmotic laxatives, intestinal secretagogues, and peripherally restricted μ-opiate antagonists are effective and safe; the lattermost drugs are a major advance for managing opioid-induced constipation. Constipation that is refractory to available laxatives should be evaluated for defecatory disorders and slow-transit constipation using studies of anorectal function and colonic transit. Defecatory disorders are often responsive to biofeedback therapies, whereas slow-transit constipation may require surgical intervention in selected patients. Both efficacy and cost should guide the choice of treatment for functional constipation and opiate-induced constipation. Currently, no studies have compared inexpensive laxatives with newer drugs that work by other mechanisms.

Original languageEnglish (US)
Pages (from-to)2340-2357
Number of pages18
JournalMayo Clinic proceedings
Volume94
Issue number11
DOIs
StatePublished - Nov 2019

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Constipation
Laxatives
Opiate Alkaloids
Primary Care Physicians
Health Expenditures
Pharmaceutical Preparations
Opioid Analgesics
Therapeutics
Delivery of Health Care
Costs and Cost Analysis

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Chronic Constipation. / Bharucha, Adil E.; Wald, Arnold.

In: Mayo Clinic proceedings, Vol. 94, No. 11, 11.2019, p. 2340-2357.

Research output: Contribution to journalReview article

Bharucha, Adil E. ; Wald, Arnold. / Chronic Constipation. In: Mayo Clinic proceedings. 2019 ; Vol. 94, No. 11. pp. 2340-2357.
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