Causes of constipation
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All psychoneurological disorders
Diagnosis of constipation
In all patients:
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Exclude structural/biochemical alterations
Identify pathophysiological role of slow colonic transit and recto-ano-pelvic dysfunction – -
Large bowel transit –
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Anorectal manometry
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Balloon expulsion test
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In neurologic patients
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Neurophysiologic investigations of the pelvic floor
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In specific patients
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Autonomic test -Defecography
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Psychiatric assessment
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Management of constipation
Slow colonic transit & normal recto-ano-pelvic function
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High fiber diet± bulk, osmotic, stimulant laxatives, isosmotic PEG electrolyte solution
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cisapride
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If severe & non responding constipation
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Malone antegrade enema; colectomy
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Slow colonic transit and no neurological control of the recto-ano-pelvic function
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High fiber diet ±bulk laxatives & trigger defecatory reflex with physical maneuvers± glycerin, stimulant laxative suppository, enema
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Cisapride
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Recto-ano-pelvic dysfunction with only partial or no denervation
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Toilet training
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Manometry-controlled biofeedback
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Isosmotic PEG electrolyte solution
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Recto-ano-pelvic dysfunction with total denervation
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Trigger defecatory reflex with physical maneuvers±glycerin, stimulant laxative suppository
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Electrostimulation of S3-S4 roots
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Hirschsprung’s d *Surgery
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