Obstipation

Constipation is a common problem that is associated with many diseases and can be caused by structural or functional pathology of the colon and rectum. It affects quality of life and results in substantial costs. Depending on the patient’s symptoms and clinical presentation, secondary causes of constipation (e.g., anorectal cancer) must be ruled out. Imaging procedures and anorectal function tests are used to differentiate slow-transit constipation from dyssynergic defecation (anismus), structural outlet obstruction (e.g., intussusception), and irritable bowel syndrome. Patients with chronic functional constipation often respond to dietary and lifestyle modification, bulking agents, and laxatives. The effects of lactulose and polyethylene glycol have been established in randomized controlled trials. With regulatory approval of lubiprostone and methylnaltrexone in Europe, new medications for the treatment of slow-transit constipation will soon become available. Biofeedback therapy is the treatment of choice in patients with anismus and in selected patients with outlet obstruction or abnormal anorectal sensitivity. In refractory cases, surgery may be indicated.