Chronic constipation is one of the most frequent gastrointestinal pathologies worldwide, and it negatively impacts the quality of life of patients. The objective of this narrative review is to present the most innovative and relevant information in relation to chronic constipation, from its pathophysiology to treatment. It is recognized that there are at least three subtypes of primary chronic constipation that are functional, that associated with irritable bowel and that related to evacuation disorders. It is considered that there are multiple causes of secondary chronic constipation, especially drugs and the entity called opioid-induced constipation is specifically detailed. The pathophysiological mechanisms of functional chronic constipation are multiple (they include motor and sensory alterations, dysbiosis, and structural and functional alterations of the pelvic floor) and frequently overlap. No test provides a complete description of defecation; therefore in general, a combination of these is generally used to assess motor and sensory structure and function. Advanced diagnostic studies of the function of the colon, rectum, and anus are recommended in patients with chronic constipation in whom the first-line treatment have failed. Regarding treatment, the usefulness of hygienic-dietary measures, exercise, fiber, the laxatives, the new drugs (such as prucalopride, lubiprostone, linaclotide, plecanatide), biofeedback therapy, probiotics, and other therapies fecal microbiota transplantation and surgery.
Aim: Manometry is the best established technique to assess anorectal function in faecal incontinence. By systematic review, pooled prevalences of anal hypotonia/hypocontractility and rectal hypersensitivity/hyposensitivity in male and female patients were determined in controlled studies using anorectal manometry.Methods: Searches of MEDLINE and Embase were completed. Screening, data extraction and bias assessment were performed by two reviewers. Meta-analysis was performed based on a random effects model with heterogeneity evaluated by I 2 .Results: Of 2116 identified records, only 13 studies (2981 faecal incontinence patients; 1028 controls) met the inclusion criteria. Anal tone was evaluated in 10 studies and contractility in 11; rectal sensitivity in five. Only three studies had low risk of bias. Pooled prevalence of anal hypotonia was 44% (95% CI 32-56, I 2 = 96.35%) in women and 27% (95% CI 14-40, I 2 = 94.12%) in men. The pooled prevalence of anal hypocontractility was 69% (95% CI 57-81; I 2 = 98.17%) in women and 36% (95% CI 18-53; I 2 = 96.77%) in men. Pooled prevalence of rectal hypersensitivity was 10% (95% CI 4-15; I 2 = 80.09%) in women and 4% (95% CI 1-7; I 2 = 51.25%) in men, whereas hyposensitivity had a pooled prevalence of 7% (95% CI 5-9; I 2 = 0.00%) in women compared to 19% (95% CI 15-23; I 2 = 0.00%) in men.
Conclusions:The number of appropriately controlled studies of anorectal manometry is small with fewer still at low risk of bias. Results were subject to gender differences, wide confidence intervals and high heterogeneity indicating the need for international collective effort to harmonize practice and reporting to improve certainty of diagnosis.
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