Constipation

ANMS Constipation Guideline

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Evidence Recommendation No evidence Poor Poor Fair Fair Poor Grade C Comment Not recommended for routine evaluation, particularly in the absence of alarm features C C B-III B-III C Not recommended for routine evaluation, particularly in the absence of alarm features Not recommended for routine evaluation, particularly in the absence of alarm features Used as an adjunct to anorectal manometry Used as an adjunct to anorectal manometry Indicated in patients younger than 50 years who have alarm symptoms Indicated in all subjects older than 50 years for colorectal cancer screening Good Good Good Good B-II A-I A-I B-II Useful to classify patients according to pathophysiological subtypes Useful to classify patients according to pathophysiological subtypes Useful to identify slow transit vs. normal transit and upper gut dysmotility such as gastroparesis Useful to establish the diagnoses of Hirschsprung's disease, impaired rectal or increased anal pressures during simulated evacuation. Even asymptomatic subjects may have dyssynergia by manometry. Dyssynergia is not always associated with impaired rectal expulsion. Good Fair B-II B-III Useful for documenting impaired evacuation. Predicts the response to pelvic floor retraining by biofeedback therapy. Reveals motor dysfunction in some patients with normal colonic transit and vice versa 5

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