Treatment of Constipation

Treatment of constipation is based on the underlying causes of constipation. If a cause of constipation can be found after proper investigation a definitive treatment can be aimed. For example if constipation is due to slow transit, it may require medical or surgical treatment and with pelvic floor dysfunction, biofeedback training is helpful in many patients (with 70–80% success rate, the success is measured by the regaining comfortable bowel habits after treatment, i.e. biofeedback training).

Majority of patients with constipation are due to slow colonic transit time. These types of patients can be treated with laxatives (such as bulk laxatives), osmotic purgatives, prokinetic agents, secretory agents, and stimulant laxatives (such as bisacodyl, psyllium, milk of magnesia, lactulose, polyethylene glycol etc.). Physical activity and drinking of plenty of fluids are also helpful in constipation. In case of slow-transit constipation that is not associated with any obstructed defecation, the patients should be tried with laparoscopic colectomy (removal of part of colon) with ileorectostomy (anastomosis between ileum and rectum), but this procedures are reserved only for patients with continued evidence of an evacuation disorder or a generalized gastrointestinal motility problem.

For treating constipation predominant IBS (irritable bowel syndrome) and severe constipation in females, newer treatment approaches can be used such as prokinetic agents (increase intestinal movements or peristalsis) and secretory agents (increase intestinal secretion) can be used.

Patients with constipation due to combined disorders (evacuation problem and transit/motility problem) can be managed with psychological counseling, pelvic floor retraining (including muscle relaxation and biofeedback) and dietary advice and in case these measures fail to correct constipation, they may be tried colectomy and ileorectostomy if colonic transit studies do not normalize and intractable symptoms persists despite biofeedback and optimum medical therapy.

It is advisable for all individuals suffering from constipation to consult physicians before using any medication for constipation. First the cause of constipation should be confirmed and than appropriate treatment can be initiated, depending on the cause.

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