coloproctology

, Volume 36, Issue 6, pp 495–505 | Cite as

Chronische Obstipation

Definition, Diagnostik und Therapie nach der S2k-Leitlinie
CME Zertifizierte Fortbildung

Zusammenfassung

Die Prävalenz der Obstipation liegt bei etwa 5 %, betroffen sind v. a. Frauen. Faserarme Kost, geringe Flüssigkeitsaufnahme und mangelnde Bewegung sind Risikofaktoren. Schwere Obstipationsformen können mit enterischen Neuropathien oder Myopathien einhergehen. Die Basisdiagnostik umfasst Anamnese, rektale und gynäkologische Untersuchung, Ultraschall sowie ggf. eine Koloskopie. Manometrie, Defäkographie und Transitzeitmessung finden bei Entleerungsstörungen oder bei therapierefraktärem Verlauf Anwendung. Die Basistherapie mit Ausgleich von Risikofaktoren und Ballaststoffgabe wird bei einer Entleerungsstörung um Suppositorien und Klysmen ergänzt, bei Refraktärität um Biofeedback oder operative Verfahren. Liegt keine Entleerungsstörung vor, beginnt die spezifische Behandlung mit einer Laxanzientherapie. Bei Ineffektivität oder Nebenwirkungen wird Prucaloprid eingesetzt, ggf. auch Linaclotid. Ferner kommen Kombinationstherapien, eine Irrigationstherapie, ein sakraler Schrittmacher oder als Ultima Ratio die subtotale Kolektomie in Betracht.

Schlüsselwörter

Epidemiologie Ätiologie Defäkographie Laxanzien Therapiealgorithmen 

Chronic constipation

Definition, diagnostics and therapy according to the S2k guidelines

Abstract

The prevalence of constipation is approximately 5 % in Germany with a predominance in women and a significant increase with age. Reduced fibre or fluid intake and sedentary behavior are risk factors and severe forms of constipation can be accompanied by enteric neuropathy and myopathy. The medical history, rectal digital and gynecological examinations, ultrasound and if indicated colonoscopy should be carried out in every patient, while manometry, defecography and colon transit time measurement should be reserved for patients with outlet obstruction or refractory constipation. The basic therapy involves elimination of risk factors and an intake of additional fibre in the diet. In outlet obstruction, suppositories and enemas are added while biofeedback therapy and surgery are restricted to refractory patients. Laxatives are initially given to constipated patients without outlet obstruction. Prucalopride or if necessary the secretagogue linaclotide are indicated when laxatives are ineffective or induce adverse effects. Combination therapy, colonic irrigation, sacral nerve stimulation and subtotal colectomy can be considered for refractory constipation.

Keywords

Epidemiology Etiology Defecography Laxatives Treatment algorithms 

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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  1. 1.Krankenhaus VilsbiburgVilsbiburgDeutschland

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