A careful history and physical examination can provide clues to find out the etiology of constipation. Only a minority of symptomatic patients seeks treatment for constipation. Treatment aims at symptomatic relief and improving the quality of life. Apart from high fiber diet and improvement in physical activity, prescription of laxatives may provide relief.
Pathophysiology (How Constipation Developes)
Constipation is the end effect of several factors including low fiber diet, lack of exercise, motility abnormalities, anatomic defects, prolonged bed rest and chronic consumption of drugs.2 Functional constipation consists of two subtypes: slow-transit constipation and dyssynergic defecation. Secondary constipation may be associated with conditions such as irritable bowel syndrome or with various medications.
Slow-transit constipation is the failure of coordinated motor activity to move the stool through the colon. The other type involves pelvic floor dysfunction or disorders of the anorectum and pelvic floor, leading to inability to adequately evacuate rectal contents. As both mechanisms may coexist in some patients, it may be difficult to ascertain the exact underlying mechanisms for constipation.3
Diagnosis of Constipation
No specific diagnostic tests have been shown to be useful in routine initial evaluation of patients with constipation. The etiologic diagnosis of chronic constipation can be achieved in most patients on a clinical basis.
Indications for physiologic tests should be based on specific clinical parameters.Patients with long-standing constipation, patients over the age of 50 years who have new-onset constipation, those whose constipation is severe and/or refractory to empiric conservative treatment, those with necessity for enemas, digital assistance and evidence of rectocele require diagnostic testing to define the cause of constipation.4
Management of Constipation
Diet and lifestyle modifications, which include increases in dietary fiber intake, water consumption and increase in physical activity, constitute the first approach to the treatment. Only if this approach fails should osmotic laxatives such as lactulose and polyethylene glycol, or stimulants like senna or bisacodyl be used.5 Stimulant laxatives and paraffin are best used intermittently because of their side-effects.
For patients with pelvic floor dyssynergia, biofeedback therapy is the first therapeutic option. If the constipation has been identified as being secondary to another condition, the primary cause should be addressed. Patients who are resistant to all the conservative modalities may require surgical intervention.1
Written by: Healthplus24 team
Date last updated: February 10, 2010