Official AGA Constipation Guidelines Pocket Guide Flipbook.
Issue link: https://eguideline.guidelinecentral.com/i/1060349
6 ➤ After discontinuing medications that can cause constipation and performing blood and other tests as guided by clinical features, a therapeutic trial (i.e., fiber supplementation and/or osmotic or stimulant laxatives) is recommended before anorectal testing (Strong; Moderate Quality of Evidence). ➤ Normal transit constipation (NTC) and slow transit constipation (STC) can be safely managed with long-term use of laxatives (Strong; Moderate Quality of Evidence). ➤ Anorectal tests should be performed in patients who do not respond to these measures (Strong; High Quality of Evidence). ➤ Pelvic floor retraining by biofeedback therapy rather than laxatives is recommended for defecatory disorders (Strong; High Quality of Evidence). Surgical Treatment ➤ When bowel symptoms are refractory to simple laxatives, newer agents should be considered in patients with NTC or STC (Conditional; Moderate Quality of Evidence). ➤ Anorectal tests and colonic transit should be reevaluated when symptoms persist despite an adequate trial of biofeedback therapy (Strong; Low Quality of Evidence). ➤ A subtotal colectomy rather than continuing therapy with chronic laxatives should be considered for patients with symptomatic STC without a defecatory disorder (Conditional; Moderate Quality of Evidence). ➤ Colonic intraluminal testing (manometry, barostat) should be considered to document colonic motor dysfunction before colectomy (Conditional; Moderate Quality of Evidence). ➤ Suppositories or enemas rather than oral laxatives alone should be considered in patients with refractory pelvic floor dysfunction (Conditional; Low Quality of Evidence). ➤ Defecography should be considered when results of anorectal manometry and rectal balloon expulsion are inconclusive for defecatory disorders (Strong; Low Quality of Evidence). ➤ Colonic transit should be evaluated if anorectal test results do not show a defecatory disorder or if symptoms persist despite treatment of a defecatory disorder (Strong; Low Quality of Evidence). Treatment Assessment