Chronic Constipation: Gastroenterohepatologist’s Approach

Abstract

<b><i>Background:</i></b> Constipation is a common problem in gastroenterological practice. The prevalence of constipation is about 16%. Constipation can be primary or secondary. <b><i>Summary:</i></b> The diagnostic and therapeutic approach to patients with constipation begins with a detailed history and physical examination. In selected cases, the use of additional diagnostic procedures is very important. This includes the use of laboratory, endoscopic, and radiological examinations, as well as advanced physiological testing (anorectal manometry, balloon expulsion test, colonic transit studies, and defecography). Constipation therapy can be both nonoperative and operative. Nonoperative therapy includes the application of a lifestyle measures, pharmacotherapy and biofeedback therapy. <b><i>Key Messages:</i></b> Two key things when taking a medical history and physical examination are to rule out the existence of alarm symptoms/signs and to rule out secondary constipation (primarily drug-induced). Therapy begins with lifestyle modification, and in case of failure, bulk or osmotic laxatives are used. In case of failure, the use of lubiprostone is indicated, as well as linaclotide. Surgical treatment of constipation is reserved for cases of refractory constipation, with delayed intestinal transit.

Effect of Lifestyle Modification on Relieving Constipation Symptoms among Patients with Liver Cirrhosis

“…The prevalence of constipation is about 16%, varies in the range of 0.7-79.0%, and is higher in women. The occurrence of constipation increases with age so that its prevalence is as high as 33% in people aged 60-110 (Milosavljevic et al, 2021).…”

“…However, its management stands on a balance between strategies for prevention and selfcare/non-pharmacological perspective. Likewise, (Milosavljevic et al, 2021) stressed the role of dietary and lifestyle modification like encouraging adequate fluid, roughage intake and regular exercise as a primary therapeutic approach to constipation regardless of etiology, which may improve constipation symptoms.…”

Anorectal manometry after rectal surgery: a case report with rectal bleeding and perforation

“…ARM provides comprehensive information about the anal sphincter and rectal sensation in patients with constipation ( 2 ) or fecal incontinence ( 3 ). Generally, the main parameters of ARM include the resting anal pressure, the anal canal maximum squeeze pressure, the spontaneous continuous squeeze time of the anal canal, the length of the anal sphincter, the initial sensory threshold, the initial defecation sensory threshold, the defecation distress threshold, the maximum volume sensory threshold, paradoxical contraction, and the anorectal inhibitory reflex.…”

“…Anorectal manometry (ARM) is primarily used to assess anorectal sensorimotor function ( 1 ). ARM provides comprehensive information about the anal sphincter and rectal sensation ( 2 ) in patients with constipation ( 3 ) or fecal incontinence. Generally, ARM can be applied to both adults and children ( 4 ).…”

Sargassum plagiophyllum Extract Enhances Colonic Functions and Modulates Gut Microbiota in Constipated Mice

“…Constipation is a health symptom that has been reported to affect approximately 8.2–32.9% of the world’s population [ 1 , 2 ]. Constipation is often defined as infrequent and/or difficult bowel movements with a hard, dry stool [ 3 , 4 ], and it can be brought on by reduced physical activity, insufficient fluid intake, medication, and depression [ 5 ]. The condition is associated with gut microbiota imbalances involving decreased numbers of Bifidobacteria and Lactobacilli, increased numbers of pathogens, and suppressed intestinal motility [ 6 ].…”