The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Evaluation and Management of Chronic Constipation
Karim AlaviAmy J. ThorsenSandy H. FangPamela L. BurgessGino T. TrevisaniAmy L. LightnerDaniel L. FeingoldIan M. Paquette
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Colorectal Surgery
Surgical oncology
Clinical Practice
Abstract: Diagnostic tools for paediatric chronic constipation have been limited, leading to over 90% of patients with treatment‐resistant constipation being diagnosed with chronic idiopathic constipation, with no discernible organic cause. Work in our institution suggests that a number of children with intractable symptoms actually have slow colonic transit leading to slow transit constipation. This paper reviews recent data suggesting that a significant number of the children with chronic treatment‐resistant constipation may have organic causes (slow colonic transit and outlet obstruction) and suggests new approaches to the management of children with chronic treatment‐resistant constipation.
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Chronic constipation is an important component of clinical gastroenterology practice worldwide. Based on the definition, either self-reported or using Rome criteria, chronic constipation can affect from 2% to 27% of the population. Constipation is physically and mentally troublesome for many patients, and can significantly interfere with their daily living and well-being. Although only a proportion of patients with constipation seek medical care, most of them use prescribed or over-the-counter medication to improve their condition. The health care costs of constipation are significant as evidenced by the hundreds of million dollars spent yearly on laxatives alone. Because constipation is more common in older patients and life expectancy is increasing, an increase in the prevalence of constipation is expected in the years to come, with the associated impact on quality of life and socioeconomic burden.
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Constipation is a complicated condition. Chronic constipation is diagnosed when constipation occurs for more than 3 months. Chronic constipation is classified using patient symptoms and the pathophysiology. New therapeutic agents to treat chronic constipation have recently been approved in Japan. However, treatments for constipation that is refractory to traditional laxatives have been approved, an algorithm for the treatment of chronic constipation has not yet been developed. The accumulation of knowledge and data is necessary to develop a new algorithm.
Refractory (planetary science)
Functional constipation
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This chapter contains sections titled: Epidemiology Psychological distress, abuse, and impact on quality of life Definition Etiology, subtypes, and pathophysiology of chronic constipation Clinical evaluation of chronic constipation Treatment of chronic constipation Complications of constipation References
Etiology
Psychological Distress
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Urinary symptoms are well-described in children with chronic constipation which include enuresis, urgency and recurrent urinary infections. Renal tract obstruction is a rare complication of severe chronic constipation. We describe a case of a 10-year-old boy with a history of long-standing constipation who presented with obstructive uropathy. Treatment strategies involved intensive medical therapy, parental education, behaviour modification strategies and close follow-up in a specialised constipation clinic. The obstruction was reversed and medications were discontinued after six months. Successful management of children with chronic constipation involves a multi-disciplinary approach in a specialised constipation clinic.
Obstructive uropathy
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Chronic constipation is an important component of clinical gastroenterology practice worldwide. Based on the definition, either self‐reported or using Rome criteria, chronic constipation can affect from 2% to 27% of the population. Constipation is physically and mentally troublesome for many patients, and can significantly interfere with their daily living and well‐being. Although only a proportion of patients with constipation seek medical care, most of them use prescribed or over‐the‐counter medication to improve their condition. The health care costs of constipation are significant as evidenced by the hundreds of million dollars spent yearly on laxatives alone. Because constipation is more common in older patients and life expectancy is increasing, an increase in the prevalence of constipation is expected in the years to come, with the associated impact on quality of life and socioeconomic burden.
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Constipation affects nearly everybody from time to time. But when it becomes chronic, constipation is a more complicated condition that can often be misunderstood and cause those affected a lot of distress. This article examines why chronic constipation in adults is an underestimated condition, and outlines some potential solutions for better care.
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Constipation is a common clinical problem in India. It is also a secondary condition in many disorders. This article focused on clinical assessment and evidence-based treatment options for managing chronic constipation in various disorders. A literature search of published medical reports in the English language was performed using PubMed from inception to 2021. The selected articles satisfied the following inclusion criteria: involved human subjects over the age of 18 years and reported at least one of the comorbidities among hypothyroidism, diabetes and hypertension along with chronic constipation. Chronic constipation is one of the most common gastrointestinal symptoms observed in patients with diabetes, hypertension or hyperthyroidism. Constipation in diabetic patients can occur due to several factors such as autonomic dysfunction, dietary habits and medications. The change in the intestinal microbiota because of chronic constipation can also induce cardiovascular events. The association between these changes and increased blood pressure in hypertension had been discussed in this review. Additionally, the link between disturbed gastrointestinal motility and chronic constipation leading to hypothyroidism had also been explored. Furthermore, the pharmacological and non-pharmacological management of chronic constipation in patients with diabetes, hypertension, and hypothyroidism have been discussed. Emphasis has been placed on the changes required in the existing treatment options for diabetes, hypertension and hypothyroidism along with the use of laxatives, dietary fibers, bulking agents, lifestyle changes and other interventions to manage chronic comorbid constipation.
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Chronic constipation is a common condition in both adults and children. Children with chronic constipation frequently have symptoms that continue into adulthood. In the second part of the review we describe advances in the identification of abnormalities in the control of motility. The role of neurotransmitters in both paediatric and adult constipation is examined and the radical rethink of colonic dysmotility caused by the re‐emergence of interstitial cells of Cajal is discussed. The recognition of chronic constipation as an heterogenous condition has led to the introduction of new therapies. Antegrade washouts through appendix stomas and an exciting new treatment with electrical interferential therapy may, in the future, result in a less invasive approach to the management of chronic constipation. An improved understanding of the assessment and management of chronic constipation in childhood is also likely to reduce the frequency and morbidity of chronic constipation in adults.
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