Constipation in Adults: Diagnosis and Management

Abstract

Symptoms of constipation occur at all ages, with the greatest prevalence in individuals older than 60 years of age. It is estimated that 35 million individuals suffer from constipation in the USA, but only a small number will ever be diagnosed. Patients identify constipation symptoms differently than physicians. Whereas a patient may define their constipation by symptoms of bloating, distension, feeling of incomplete evacuation, abdominal discomfort, hard stools, and excessive straining, physicians often interpret prolonged timing between movements as the most essential criteria. An evaluation of constipation begins with a focused history of a person's bowel habit, medications, diet, physical activity, and an anorectal examination. In the absence of alarm signs, diagnostic testing for constipation is not routinely recommended in the initial evaluation. First-line management includes lifestyle changes of increased physical activity, high-fiber diets, adequate fluid intake, and bowel management techniques such as a straight back sitting position, using known triggers to stimulate bowel contractions, and a foot stool to elevate knees above bottom during toileting. When refractory to initial management, patients should have anorectal manometry to assess outlet function; additional testing may be required. Biofeedback is an effective treatment option for dyssynergic defecation. A range of traditional and new pharmacologic therapies are available to remedy constipation, from stool softeners to agents that increase intestinal transit. Managing the primary and secondary causes of constipation, incorporating effective bowel management techniques, along with the judicious use of laxatives can reduce constipation symptoms and improve quality of life.

Electrical neuromodulation at acupoint ST36 normalizes impaired colonic motility induced by rectal distension in dogs

“…gastrointestinal motility; colonic motility; electroacupuncture; electrical stimulation; vagal pathway THE FUNCTIONAL GASTROINTESTINAL disorders (FGIDs) are highly prevalent, accounting for 45-68% of gastrointestinal presentations to primary care facilities. It is estimated that 35 million individuals suffer from constipation in the United States (11). Irritable bowel syndrome (IBS) represents 29.8% (or 2.4 -3.5 million) of all physician visits per annum in the United States (14).…”

“…Irritable bowel syndrome (IBS) represents 29.8% (or 2.4 -3.5 million) of all physician visits per annum in the United States (14). FGIDs cost healthcare industries hundreds of billion per year in United States (4,11,16). At least two of major FGIDs are related to dysfunction of colonic motility: chronic constipation and IBS.…”

“…Biofeedback has been reported to be effective in treatment of constipation with paradoxical contractions of the rectum and anal sphincter (1,48) but not for constipation with slow transit. Some overlap symptoms of those diseases are resistant to those treatments because of the weak effects of some drugs or the long-term history of diseases, and some of therapies are limited due to their side effects (11). Therefore, safe and effective methods for treatment of those diseases are deeply needed.…”

Constipation: Causes and concern

“…Al though stim u lant lax a tives are more ef fi cient than bulk-form ing lax a tives, they also are more likely to cause di ar rhea and ab dom i nal pain. Ev i dence sup ports treat ment with Senna and fi ber supplementation 15 Os motic lax a tives are quite ben e fi cial in some pa tients and a short-term use of os motic or stim u lant lax a tives should re served for pa tients who fail to re spond to dietary changes or bulk ing agents 16 .…”

Emergency Department Burden of Constipation in the United States from 2006 to 2011

“…Although most oft en mild to moderate and managed through lifestyle changes and pharmacological therapies ( 13,14 ), constipation can be severe, diffi cult to manage, and result in signifi cant sequelae ( 7 ). Although patients with CC are typically treated as outpatients, a recent study found that 48,450 patients were discharged from the US hospitals with a primary diagnosis of constipation and aggregate annual costs in excess of $850 million (adjusted for infl ation) in 2010 ( 15 ).…”