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Pathophysiology, diagnosis and current management of chronic constipation

Nature Clinical Practice Gastroenterology & Hepatology volume 3, pages 90–100 (2006)Cite this article

Abstract

Chronic constipation is prevalent in Western countries and is a complaint that is commonly seen in clinical practice. Only a relatively small percentage of constipated patients seek medical evaluation and most can be managed satisfactorily with first-line, conservative therapy. In patients with severe, refractory constipation, additional studies of colonic and anorectal function have clinical utility, as such patients are candidates for therapies not given to most constipated patients. This article reviews the modern principles and therapies used to manage chronic constipation of varying severities.

Key Points

  • Chronic constipation can occur because of a primary motor disorder, in association with numerous diseases, or as a side effect of many drugs

  • A physical examination including neurologic examination and abdominal palpation should be performed before undertaking other diagnostic tests

  • A 2-week, prospectively obtained bowel diary and measurement of colonic transit time are the most useful diagnostic studies

  • First-line treatments include bulking agents, osmotic laxatives, stimulant laxatives, and enterokinetic agents

  • When first-line treatments fail, surgery, antegrade colonic enemas and behavioral approaches should be considered

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Figure 1: Anal sphincter electromyographic and pressure responses to straining as if to defecate.
Figure 2: Evaluation and classification of idiopathic chronic constipation.
Figure 3: Treatment options for severe constipation.

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Acknowledgements

The author thanks Helen Gibson for her expert preparation of the manuscript.

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Authors and Affiliations

  1. Professor of Medicine at the University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Arnold Wald

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Correspondence to Arnold Wald.

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The author is or has acted as a medical advisor to Novartis, GlaxoSmithKline, Boehringer-Ingelheim and Takeda Pharmaceuticals, and as a legal advisor to Schering-Plough and Novartis on matters pertaining to senna and biscodyl.

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Wald, A. Pathophysiology, diagnosis and current management of chronic constipation. Nat Rev Gastroenterol Hepatol 3, 90–100 (2006). https://doi.org/10.1038/ncpgasthep0406

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