Figure 2. Gastrointestinal Motility Evaluation and Treatment of Chronic Constipation
Chronic constipation and difficult defecation – motility evaluation
+ colonic transit test (CTT) with radio-opaque marker or WMC ± defecography
Anorectal manometry (ARM) + balloon expulsion test (BET)
Consider documenting bowel symptoms by a 2 week bowel diary
Normal tests
Normal ARM + Normal BET
Delayed CTT
Therapeutic trial
Slow-transit constipation
improvement No
Psychological evaluation and therapy
secretagogues
Prokinetics, laxatives,
improvement No
ARM, EMG or imaging
Abnormal
Dyssynergic defecation
Anatomical defect
sensation
Impaired rectal
Hirschsprung Rectal prolapse
Biofeedback Mucosal: Biofeedback Full thickness: Surgery
Colonic manometry to identify colonic motor dysfunction
Colonic neuropathy Colectomy 7
