Evaluation of Constipation and Treatment of Abdominal Constipation
Constipation is a prevalent condition that can have significant effects on quality of life. Initial treatment should include behavioral modification and fiber supplementation or laxatives. In patients that require further intervention, testing modalities
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Key Concepts • There are three constipation subtypes which can be differentiated by symptoms and diagnostic testing, although there can be overlap between subtypes. • Initial treatment of constipation includes behavioral modification and medication. • Surgical management of constipation is reserved for severe slow transit constipation that is not responsive to medications.
Prevalence Constipation is an extremely common complaint and in North America alone it is estimated that 63 million people suffer from constipation. The prevalence has been estimated between 2 and 27 % and accounts for 2.5 million physician visits annually [1, 2]. Women report a two- to three-fold higher incidence of constipation than their male counterparts. In a survey study of 600 healthy women from Spain, almost a third had functional constipation symptoms [3]. In another study of patients presenting to European tertiary care centers for idiopathic constipation, 92 % were women, and furthermore, women were more likely to have a diagnosis of slow transit constipation [4]. There is a higher incidence of constipation in non-Caucasians as well as individuals with less education and lower income. Additionally, multiple studies have found older patients have a higher prevalence of constipation, particularly over the age of 65 [5–8].
Etiology of Constipation Defecation is a complex process that results from stool formation, gastrointestinal motility, and pelvic floor function. Constipation may result from dysfunction of any portion of
the defecatory process. Contributing factors may include diet, medications, neurologic or endocrine disorders, psychosocial issues, colonic disease, or pelvic floor abnormalities (Table 58-1). Often patients may have constipation with no identifiable cause.
Rome Criteria and Constipation Subtypes In an effort to standardize the definitions associated with constipation, a symptom-based classification was established by consensus approach. The most recent iteration was created by the Rome Committee in 2006 and is termed the Rome III Criteria [9]. For functional constipation, criteria (Table 58-2) must be met for the last 3 months, with symptom onset at least 6 months prior to diagnosis [10]. Constipation can be further categorized into the following subtypes: slow transit constipation, normal transit constipation, or pelvic constipation. Slow transit constipation or abdominal constipation is a motility disorder and stool moves through the colon at a slow rate. In some patients, only the colon is affected, while in others, there may be involvement of other portions of the gastrointestinal tract. Patients with slow transit constipation may not have bowel movements for days to weeks at a time, despite using laxatives and enemas. Normal transit constipation, also termed constipation predominant-irritable bowel syndrome, is a functional disorder characterized by normal transit through the gastrointestinal tract, however, stools are hard and defecation may be difficult. Additionally, patients may complain of abdominal pain and bl
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