Diagnosis and treatment of chronic constipation - a European perspective

Abstract

BackgroundAlthough constipation can be a chronic and severe problem, it is largely treated empirically. Evidence for the efficacy of some of the older laxatives from well-designed trials is limited. Patients often report high levels of dissatisfaction with their treatment, which is attributed to a lack of efficacy or unpleasant side-effects. Management guidelines and recommendations are limited and are not sufficiently current to include treatments that became available more recently, such as prokinetic agents in Europe.PurposeWe present an overview of the pathophysiology, diagnosis, current management and available guidelines for the treatment of chronic constipation, and include recent data on the efficacy and potential clinical use of the more newly available therapeutic agents. Based on published algorithms and guidelines on the management of chronic constipation, secondary pathologies and causes are first excluded and then diet, lifestyle, and, if available, behavioral measures adopted. If these fail, bulk-forming, osmotic, and stimulant laxatives can be used. If symptoms are not satisfactorily resolved, a prokinetic agent such as prucalopride can be prescribed. Biofeedback is recommended as a treatment for chronic constipation in patients with disordered defecation. Surgery should only be considered once all other treatment options have been exhausted.

Guidelines for the Diagnosis and Treatment of Chronic Functional Constipation in Korea, 2015 Revised Edition

“…19,22,26,43 However, routine colonoscopy is not warranted for most patients with chronic constipation, because the prevalence of colonic neoplasms at colonoscopy is comparable to that in patients without chronic constipation. 44 Digital rectal examination 8.…”

“…The BSFS is a reliable indicator of CTT 38 and particularly useful in patients reporting some discrepancy between the frequency of bowel movements and stool hardness. 26 Some patients complain of having constipation with a normal frequency of bowel movement and hard or lumpy stool, but in some cases, patients consider constipation to be having rare bowel movements with normal stool consistency. No correlation has been observed between stool frequency and measured transit in constipated or healthy adults.…”

“…Pelvic floor dysfunction may contribute to constipation with or without delayed transit. 26 STC is defined as prolonged delay in the passage of the stool through the colon. Slow transit is related to reduce colonic propulsive activity or increased uncoordinated motor activity of the colon.…”

Clinical and economic profile of prucalopride in the treatment of chronic constipation in women

“…La Tabella I riporta le principali classi di lassativi, indicandone meccanismo d'azione e fattori limitanti il loro uso clinico [34][35][36]. La maggior parte dei lassativi sono farmaci di uso consolidato o tradizionale, disponibili come prodotti da banco, senza ricetta.…”

Comparison of efficacies of vegetable oil based and polyethylene glycol based bisacodyl suppositories in treating patients with neurogenic bowel dysfunction after spinal cord injury: A meta-analysis

“…The bisacodyl (bis (p-acetoxyphenyl)-2-pyridylmethane) is a stimulant laxative widely used in treating constipation (15). It acts directly on the mucous membrane, stimulating the sensory nerves for a parasympathetic nerve reflex response, and thereby increases intestinal tract secretion and movement (16,17). Bisacodyl was first used as a laxative in 1953 due to its structural similarity to phenolphthalein, and has since been used for the successful management of NBD (14).…”