7
Figure 3. Treatment Algorithm for Chronic Constipation
Interview and physical
examination
Inconclusive
Abnormal
Consider metabolic and
structural evaluation,
baseline labs
Therapeutic trial:
fiber ± laxatives
Inadequate response
Anorectal manometry
balloon expulsion test
a
Normal
Barium or MR
defecography
Defecatory
disorder
Normal Abnormal
Colonic transit
Slow Normal
Slow transit
constipation
Normal transit
constipation
a
Because anorectal manometry, rectal balloon expulsion test may not be available in all practice
settings, it is acceptable, in such circumstances, to proceed to assessing colonic transit with the
understanding that delayed colonic transit does not exclude a defecatory disorder.
Treatment
