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➤ After discontinuing medications that can cause constipation and
performing blood and other tests as guided by clinical features,
a therapeutic trial (ie, 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
