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Causes of constipation

  • All psychoneurological disorders

Diagnosis of constipation

In all patients:

    • Exclude structural/biochemical alterations
      Identify pathophysiological role of slow colonic transit and recto-ano-pelvic dysfunction –
    • Large bowel transit –
    • Anorectal manometry
    • Balloon expulsion test

In neurologic patients

    • Neurophysiologic investigations of the pelvic floor

In specific patients

    • Autonomic test -Defecography
    • Psychiatric assessment

Management of constipation

Slow colonic transit & normal recto-ano-pelvic function

    • High fiber diet± bulk, osmotic, stimulant laxatives, isosmotic PEG electrolyte solution
    • cisapride

If severe & non responding constipation

    • Malone antegrade enema; colectomy

Slow colonic transit and no neurological control of the recto-ano-pelvic function

    • High fiber diet ±bulk laxatives & trigger defecatory reflex with physical maneuvers± glycerin, stimulant laxative suppository, enema
    • Cisapride

Recto-ano-pelvic dysfunction with only partial or no denervation

    • Toilet training
    • Manometry-controlled biofeedback
    • Isosmotic PEG electrolyte solution

Recto-ano-pelvic dysfunction with total denervation

    • Trigger defecatory reflex with physical maneuvers±glycerin, stimulant laxative suppository
    • Electrostimulation of S3-S4 roots
    • Hirschsprung’s d *Surgery