Refractory Constipation: How to Evaluate and Treat

Michael Camilleri, Justin Brandler

Research output: Contribution to journalReview articlepeer-review


Patients are often referred for treatment of refractory constipation that may result from uncontrolled underlying disease or ineffective treatment. This article reviews clinical testing in patients with refractory constipation, differentiating subtypes of primary chronic idiopathic constipation, and common pitfalls in assessment of refractory chronic constipation. The constipation may also be refractory because of significant associated diseases affecting the colon and resulting in slow transit constipation. The choice of therapy is best guided by the subtype. Management of refractory constipation requires correct diagnosis and individualized treatment, which may rarely include conservative surgery (loop ileostomy).

Original languageEnglish (US)
Pages (from-to)623-642
Number of pages20
JournalGastroenterology Clinics of North America
Issue number3
StatePublished - Sep 2020


  • Colonic inertia
  • Descending perineum syndrome
  • Dyssynergia
  • Evacuation disorder
  • Slow transit constipation

ASJC Scopus subject areas

  • Gastroenterology


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