Chapter 31 - Chronic constipation

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Abstract

Chronic constipation (CC) is a prevalent global healthcare problem, causing considerable economic burden and negatively impacts on quality of life. The current ROME IV defines Functional Constipation as a functional bowel disorder in which symptoms of difficult, infrequent, or incomplete defecation predominate. The Bristol Stool Form Scale is a more reliable surrogate marker for colonic transit than defecatory frequency or change in bowel output. Alert symptoms, such as bloating or fullness, difficult to pass stools, need for laxatives and other constipation symptoms should prompt the physician to consider a diagnosis of constipation. Treatment trials with increasing dietary fiber failed to show improvement in patients with CC. In fact, the addition of high fiber may aggravate constipation. This chapter also discusses a step-up approach for medical therapy to chronic constipation. Lastly, the entity of refractory constipation is poorly defined, and establishing an accepted definition facilitates comparison of treatments for truly refractory constipation, and for the benefit of avoiding unnecessary surgery for patients.

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