Constipation and Constipation Syndromes

Chronic constipation is a common symptom. After excluding a secondary cause, dietary fiber supplementation and simple laxatives are preferred initial options for patients with chronic constipation. Colonic transit and anorectal functions should be assessed in patients with refractory symptoms, allowing patients to be categorized into three groups (i.e., normal transit constipation, slow-transit constipation, and defecatory disorders). While normal and slow transit constipation are generally amenable to laxatives and/or colonic prokinetic agents, pelvic floor retraining by biofeedback therapy is the cornerstone for managing defecatory disorders. Anorectal manometry and a rectal balloon expulsion test generally suffice for diagnosing defecatory disorders; magnetic resonance imaging (MRI) or barium proctography are necessary for selected patients only. New agents (lubiprostone, linaclotide, and prucalopride) should be considered in patients who do not respond to over-the-counter agents. A subtotal colectomy is necessary and beneficial for a small proportion of patients with slow-transit constipation who do not have a defecatory disorder.