Primary Care Management of Chronic Constipation in Asia: The ANMA Chronic Constipation Tool

Abstract

Chronic constipation (CC) may impact on quality of life. There is substantial patient dissatisfaction; possible reasons are failure to recognize underlying constipation, inappropriate dietary advice and inadequate treatment. The aim of these practical guidelines intended for primary care physicians, and which are based on Asian perspectives, is to provide an approach to CC that is relevant to the existing health-care infrastructure. Physicians should not rely on infrequent bowel movements to diagnose CC as many patients have one or more bowel movement a day. More commonly, patients present with hard stool, straining, incomplete feeling, bloating and other dyspeptic symptoms. Physicians should consider CC in these situations and when patients are found to use laxative containing supplements. In the absence of alarm features physicians may start with a 2-4 week therapeutic trial of available pharmacological agents including osmotic, stimulant and enterokinetic agents. Where safe to do so, physicians should consider regular (as opposed to on demand dosing), combination treatment and continuous treatment for at least 4 weeks. If patients do not achieve satisfactory response, they should be referred to tertiary centers for physiological evaluation of colonic transit and pelvic floor function. Surgical referral is a last resort, which should be considered only after a thorough physiological and psychological evaluation.

Development, Translation and Validation of Enhanced Asian Rome III Questionnaires for Diagnosis of Functional Bowel Diseases in Major Asian Languages: A Rome Foundation-Asian Neurogastroenterology and Motility Association Working Team Report

“…One possible explanation is the discrepancy between the patients' perception which places importance to hardness of stool and incomplete evacuation, and the physicians' concept of constipation which emphasizes infrequent bowel movement. 32 In a study from South Korea it was observed that close to three-quarters of patients who complained of hard stools failed to meet Rome criteria for hard stools. 31 There are studies from Asia which point to shorter colonic transit times relative to those reported from the West.…”

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

“…129 The majority of clinical guidelines, including Korean guidelines, have indicated the efficacy of PEG in patients with chronic constipation with high evidence and recommendations. 9,19,42,[132][133][134] 26. Statement : Polyethylene glycol may be effective in improving bowel frequency and constipation-related symptoms in elderly patients with chronic constipation.…”

Dyssynergic defecation: The not so hidden partner in constipation

“…AGA suggested that patients with high suspicion for DD should be referred for early anorectal testing [16]. Asian Neurogastroenterology and Motility Association (ANMA) Chronic Constipation tool suggested that lower GI physiological evaluation should be considered when a patient fails to respond to conventional laxative therapy [20]. In a multicenter study involving 1376 patients with functional GI disorders from 11 cities across Asia, it was found that constipation had the lowest satisfaction with previous consultation (29.2%) and the most bothersome symptom was straining (37.5%) [21].…”