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Constipation

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9 Figure 5. Treatment Algorithm for Defecating Disorders Defecatory disorder Pelvic floor retraining ± dietitian, psychology Follow clinically Repeat balloon expulsion test Improvement No Improvement Defecating/ MR proctogram Colonic transit Abnormal Normal Slow transit constipation Normal transit constipation Slow Normal Yes No Consider surgery Normal anal/ pelvic floor relaxation Abnormal anal/ pelvic floor relaxation Clinically significant structural abnormality Reassess biofeedback, PRN suppositories, enemas Consider fallback options

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