Evaluation and Management of Chronic Constipation
Publication Date: September 10, 2024
Last Updated: September 11, 2024
Summary of Recommendations
A directed history and physical examination should be performed in patients presenting with constipation. (S, L )
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Objective measures assessing the nature, severity, and impact of constipation on quality of life can be useful when evaluating patients with constipation. (C, L )
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The initial management of patients with symptomatic constipation involves dietary modifications and ensuring adequate fluid intake and fiber supplementation. (S, L )
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Osmotic laxatives are an appropriate first line medical therapy to manage chronic constipation. Stimulant laxatives, such as bisacodyl, can be considered for rescue therapy or as second-line therapy, if needed. (S, M )
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Patients who fail to improve with dietary changes, fiber therapy, and osmotic laxatives should be evaluated for outlet dysfunction. Anorectal physiology testing or dynamic imaging by fluoroscopic defecography, MRI defecography, or dynamic ultrasound may help identify functional or structural causes related to an evacuation disorder. (C, L )
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Colonic motility and transit should be measured before surgical intervention is considered. (S, L )
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Biofeedback therapy is considered a firs tline treatment for patients with symptomatic pelvic floor dyssynergia. (S, M )
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Injecting botulinum toxin into the puborectalis and external sphincter muscle may be considered in patients with outlet dysfunction constipation related to nonrelaxing puborectalis muscle. (C, L )
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Patients with significant outlet dysfunction from a rectocele may be considered for surgical repair after addressing any concomitant functional causes, such as nonrelaxing puborectalis muscle. (C, M )
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STARR is not recommended for the repair of a rectocele or internal rectal intussusception because of the high complication rates associated with this procedure. (S, M )
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Repair of rectal intussusception may be considered in patients with severe obstructed defecation in whom nonoperative treatments were unsuccessful. (C, L )
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Patients with isolated refractory colonic slow-transit constipation may benefit from total abdominal colectomy with ileorectal anastomosis. (C, L )
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Fecal diversion may be considered in patients with intractable constipation refractory to other treatment options. (C, L )
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The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.
Title
Evaluation and Management of Chronic Constipation
Authoring Organization
American Society of Colon and Rectal Surgeons
Publication Month/Year
September 10, 2024
Last Updated Month/Year
September 20, 2024
Country of Publication
US
Health Care Settings
Ambulatory, Outpatient, Operating and recovery room
Intended Users
Nurse, nurse practitioner, physician, physician assistant
Scope
Assessment and screening, Treatment, Management
Diseases/Conditions (MeSH)
D003248 - Constipation
Keywords
constipation, chronic constipation
Source Citation
Alavi, Karim M.D., M.P.H.1; Thorsen, Amy J. M.D.2; Fang, Sandy H. M.D.3; Burgess, Pamela L. M.D.4; Trevisani, Gino M.D.5; Lightner, Amy L. M.D.6; Feingold, Daniel L. M.D.7; Paquette, Ian M. M.D.8; On behalf of the Clinical Practice Guidelines Committee of the American Society of Colon and Rectal Surgeons. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Evaluation and Management of Chronic Constipation. Diseases of the Colon & Rectum 67(10):p 1244-1257, October 2024. | DOI: 10.1097/DCR.0000000000003430
Methodology
Number of Source Documents
136
Literature Search Start Date
January 1, 2014
Literature Search End Date
February 1, 2024