Constipation and Constipation Syndromes

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

Chronic constipation is a common symptom. After excluding a secondary cause, dietary fiber supplementation and simple laxatives are preferred initial options for patients with chronic constipation. Colonic transit and anorectal functions should be assessed in patients with refractory symptoms, allowing patients to be categorized into three groups (i.e., normal transit constipation, slow-transit constipation, and defecatory disorders). While normal and slow transit constipation are generally amenable to laxatives and/or colonic prokinetic agents, pelvic floor retraining by biofeedback therapy is the cornerstone for managing defecatory disorders. Anorectal manometry and a rectal balloon expulsion test generally suffice for diagnosing defecatory disorders; magnetic resonance imaging (MRI) or barium proctography are necessary for selected patients only. New agents (lubiprostone, linaclotide, and prucalopride) should be considered in patients who do not respond to over-the-counter agents. A subtotal colectomy is necessary and beneficial for a small proportion of patients with slow-transit constipation who do not have a defecatory disorder.

Original languageEnglish (US)
Title of host publicationTextbook of Clinical Gastroenterology and Hepatology
Subtitle of host publicationSecond Edition
PublisherWiley-Blackwell
Pages462-471
Number of pages10
ISBN (Print)1405191821, 9781405191821
DOIs
StatePublished - Apr 16 2012

Keywords

  • Anorectal manometry
  • Colon physiology
  • Constipation
  • Defecation
  • Defecatory disorders
  • Laxatives
  • Pelvic floor dysfunction
  • Proctography
  • Prokinetic agents

ASJC Scopus subject areas

  • Medicine(all)

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  • Cite this

    Bharucha, A. E., & Grover, M. (2012). Constipation and Constipation Syndromes. In Textbook of Clinical Gastroenterology and Hepatology: Second Edition (pp. 462-471). Wiley-Blackwell. https://doi.org/10.1002/9781118321386.ch61