Approach to Patients with Refractory Constipation
A review of relevant publications revealed that the criteria for defining refractory constipation were ill-defined. Common treatment for constipation includes osmotic, stimulant, and enterokinetic agents. Prucalopride is a new enterokinetic agent that has been shown in clinical trials to produce significant improvements in bowel functions, gastrointestinal symptoms, and quality of life. Patients who fail pharmacological treatment should be referred to specialized centers for physiological laboratory evaluation like transit studies, balloon expulsion, anorectal manometry, and defecography. Potential pathophysiology of refractory constipation include physiological disturbances like pelvic floor dyssynergia and slow transit constipation. Physical defects such as rectocoele and internal prolapse are uncommon. Psychological disturbances have been linked to persistent GI symptoms. Non-pharmacological treatments to consider include biofeedback and behavioral therapy. More studies are needed before surgery can be recommended. There is the possibility that a wider acceptance of the use of laxatives may substantially reduce the number of patients with refractory constipation.
KeywordsConstipation Laxative Biofeedback Psychological Surgery Bowel
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