Constipation is a common gastrointestinal disorder which impacts on patients’ quality of life (QoL). Its prevalence varies between 3% to 27%. The incidence appears to increase with age. There is no widely accepted definition of constipation. Patients may experience reduced bowel evacuation frequency, abdominal pain, and bloating. The Rome II criteria stipulates three or less bowel movements per week for a minimum of 12 weeks as a criteria to define constipation, whereas other accepted definitions include two or fewer bowel evacuations per week or straining at stool more than 25% of the time .
Constipation can been subdivided into slow transit constipation, obstructive defecation or rectal evacuation disorder, or a combination of the two. Other forms mentioned in the literature include impaired pelvic floor relaxation (pelvic dyssynergia or anismus) and constipation-predominant irritable bowel syndrome. Slow transit constipation is thought to account for between 15 to 37% of cases.
Up to a third of patients with constipation access healthcare for their symptoms and a significant number report abdominal pain, bloating and poor quality of life (QoL). Due to its high prevalence and associated economic and QoL implications, constipation is now considered a major public health issue.
There are several treatments available for constipation. It is essential to rule out an organic pathology and investigate with colonoscopy and scans to ensure this. The nature of constipation also decides on other investigations needed. Some patients need a proctogram, enoanal ultrasound, physiology studies, transit studies and MRI pelvis.
Most patients with constipation are treated with dietary modification, lifestyle advice, and laxatives. Biofeedback has a role in patients with constipation. Other treatments available include newer medication which are useful in slow transit constipation.
Physiotherapy, use of suppositories and rectal irrigation all form part of the treatments available. A small number of patients with severe, unresponsive constipation can be treated with sacral nerve stimulation or resectional surgery.