Chronic constipation

Abstract

Chronic constipation is a prevalent condition that severely impacts the quality of life of those affected. Several types of primary chronic constipation, which show substantial overlap, have been described, including normal-transit constipation, rectal evacuation disorders and slow-transit constipation. Diagnosis of primary chronic constipation involves a multistep process initiated by the exclusion of 'alarm' features (for example, unintentional weight loss or rectal bleeding) that might indicate organic diseases (such as polyps or tumours) and a therapeutic trial with first-line treatments such as dietary changes, lifestyle modifications and over-the-counter laxatives. If symptoms do not improve, investigations to diagnose rectal evacuation disorders and slow-transit constipation are performed, such as digital rectal examination, anorectal structure and function testing (including the balloon expulsion test, anorectal manometry or defecography) or colonic transit tests (such as the radiopaque marker test, wireless motility capsule test, scintigraphy or colonic manometry). The mainstays of treatment are diet and lifestyle interventions, pharmacological therapy and, rarely, surgery. This Primer provides an introduction to the epidemiology, pathophysiological mechanisms, diagnosis, management and quality of life associated with the commonly encountered clinical problem of chronic constipation in adults unrelated to opioid abuse.

Chronic idiopathic constipation in adults: epidemiology, pathophysiology, diagnosis and clinical management

“…Despite normal transit constipation being the most prevalent subgroup of CIC, the pathophysiology remains unclear 23 . Changes in the colonic microbiota can increase bile acid metabolism, 24 promote methane production 25 and affect epithelial function, all of which can alter colonic motility and fluid secretion, resulting in constipation 26 .…”

“…A study in patients with IBS found that increased physical activity improved gastrointestinal symptoms and was also protective against a deterioration in symptoms, 63 effects which might be mediated through positive effects on anti‐inflammatory and anti‐oxidant pathways, as well as immune function 64 . In CIC specifically, although intervention programs to increase physical activity may be of some help in older patients, 62 there is no evidence to suggest that increasing levels of physical activity in younger people is beneficial 23 …”

“…When slow transit constipation and DD coexist, DD should be corrected before surgery. If this is not achievable, then formation of an ileostomy is the only suitable surgical intervention 23 …”

“…22 Pathophysiology Normal transit (functional) constipation Despite normal transit constipation being the most prevalent subgroup of CIC, the pathophysiology remains unclear. 23 Changes in the colonic microbiota can increase bile acid metabolism, 24 promote methane production 25 and affect epithelial function, all of which can alter colonic motility and fluid secretion, resulting in constipation. 26 As with other functional gastrointestinal disorders, there are also dietary and other lifestyle, behavioural and psychological factors that may be involved in the aetiology of symptoms.…”

Prevalence and impact of self‐reported painful and non‐painful constipation in the general population

“…The number of participants in our survey who experienced abdominal pain besides constipation, and who could therefore be considered close to the IBS‐C spectrum could explain the higher number of doctor visits in this study. A subgroup of patients with constipation, more specifically those with normal‐transit constipation have been reported to overlap considerably with IBS‐C . No specification of transit data was available for the current epidemiological study; however, normal‐transit constipation is thought to make up the largest group of constipated patients.…”