Chronic constipation: A review of literature

Mojgan Forootan, Nazila Bagheri, Mohammad Darvishi, Mojgan Forootan, Nazila Bagheri, Mohammad Darvishi

Abstract

Background: Chronic constipation is described as a common complication determined by difficult and/or rare passage of stool or both. The difference in definition of constipation has led to a wide range of reported prevalence (i.e., between 1% and 80%). Various factors are involved in the pathogenesis of the disease, including type of diet, genetic predisposition, colonic motility, absorption, social economic status, daily behaviors, and biological and pharmaceutical factors. Diagnostic and therapeutic options play a key role in the treatment of chronic constipation. There are still debates about the timing of these diagnostic and therapeutic algorithms.

Methods: A systematic and comprehensive search will be performed using MEDLINE, PubMed, EMBASE, AMED, the Cochrane Library and Google Scholar. Better understanding of the pathophysiology of chronic constipation and efficacy of pharmacological agent can help physicians for treating and managing symptoms.In this study, some of the old and new therapies in the treatment of chronic constipation have been studied based on the controlled studies and strong evidence. We are trying to address some of the controversial issues to manage the disease and to provide appropriate diagnostic options in an efficient and cost-effective way.

Results: The results of this systematic review will be published in a peer-reviewed journal.

Conclusion: To our knowledge, our study will provide an overall estimate of chronic constipation to assess controversial issues, available diagnostic and therapeutic strategies of chronic constipation.

Ethics and dissemination: Ethical approval and informed consent are not required, as the study will be a literature review and will not involve direct contact with patients or alterations to patient care.

Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Four patterns of anorectal manometry in the dyssynergic defecation.[49,55]
Figure 2
Figure 2
Suggested diagnostic and management algorithm for chronic constipation.

References

    1. Benninga M, Candy DC, Catto-Smith AG, et al. The Paris Consensus on Childhood Constipation Terminology (PACCT) Group. J Pediatr Gastroenterol Nutr 2005;40:273–5.
    1. Sanchez MI, Bercik P. Epidemiology and burden of chronic constipation. Can J Gastroenterol 2011;25: 11B-L 15B.
    1. Suares NC, Ford AC. Systematic review: the effects of fibre in the management of chronic idiopathic constipation. Aliment Pharmacol Ther 2011;33:895–901.
    1. Wald A, Scarpignato C, Kamm MA, et al. The burden of constipation on quality of life: results of a multinational survey. Aliment Pharmacol Ther 2007;26:227–36.
    1. Everhart JE, Ruhl CE. Burden of digestive diseases in the United States part II: lower gastrointestinal diseases. Gastroenterology 2009;136:741–54.
    1. Galvez C, Garrigues V, Ortiz V, et al. Healthcare seeking for constipation: a population-based survey in the Mediterranean area of Spain. Aliment Pharmacol Ther 2006;24:421–8.
    1. Iraji N, Keshteli AH, Sadeghpour S, et al. Constipation in Iran: SEPAHAN systematic review. Int J Prev Med 2012;3:S34–41.
    1. Chu H, Zhong L, Li H, et al. Epidemiology characteristics of constipation for general population, pediatric population, and elderly population in China. Gastroenterol Res Pract 2014;2014:532734.
    1. Mugie SM, Benninga MA, Di Lorenzo C. Epidemiology of constipation in children and adults: a systematic review. Best Pract Res Clin Gastroenterol 2011;25:3–18.
    1. Vazquez Roque M, Bouras EP. Epidemiology and management of chronic constipation in elderly patients. Clin Interv Aging 2015;10:919–30.
    1. Bharucha AE, Pemberton JH, Locke GR. American gastroenterological association technical review on constipation. Gastroenterology 2013;144:218–38.
    1. Tack J, Müller-Lissner S, Stanghellini V, et al. Diagnosis and treatment of chronic constipation—a European perspective. Neurogastroenterol Motil 2011;23:697–710.
    1. Dukas L, Willett WC, Giovannucci EL. Association between physical activity, fiber intake, and other lifestyle variables and constipation in a study of women. Am J Gastroenterol 2003;98:1790–6.
    1. Haug TT, Mykletun A, Dahl AA. Are anxiety and depression related to gastrointestinal symptoms in the general population? Scand J Gastroenterol 2002;37:294–8.
    1. Lu CL, Chang FY, Chen CY, et al. Significance of Rome II-defined functional constipation in Taiwan and comparison with constipation-predominant irritable bowel syndrome. Aliment Pharmacol Ther 2006;24:429–38.
    1. Tucker DM, Sandstead HH, Logan GM, Jr, et al. Dietary fibre and personality factors as determinants of stool output. Gastroenterology 1981;81:879–83.
    1. Voderholzer WA, Schatke W, Muhldorfer BE, et al. Clinical response to dietary fibre treatment of chronic constipation. Am J Gastroenterol 1997;92:95–8.
    1. Basilisco G, Coletta M. Chronic constipation: a critical review. Dig Liver Dis 2013;45:886–93.
    1. Suares NC, Ford AC. Prevalence of, and risk factors for, chronic idiopathic constipation in the community: systematic review and meta-analysis. Am J Gastroenterol 2011;106:1582–91.
    1. Bijkerk CJ, Muris JWM, Knottnerus JA, et al. Systematic review: the role of different types of fibre in the treatment of irritable bowel syndrome. Aliment Pharmacol Ther 2004;19:245–51.
    1. Cook IJ, Talley NJ, Benninga MA, et al. Chronic constipation: overview and challenges. Neurogastroenterol Motil 2009;21:1–8.
    1. Lunniss PJ, Gladman MA, Benninga MA, et al. Pathophysiology of evacuation disorders. Neurogastroenterol Motil 2009;21:31–40.
    1. Scott SM, van den Berg MM, Benninga MA. Rectal sensorimotor dysfunction in constipation. Best Pract Res Clin Gastroenterol 2011;25:103–18.
    1. Chan CL, Lunniss PJ, Wang D, et al. Rectal sensorimotor dysfunction in patients with urge faecal incontinence: evidence from prolonged manometric studies. Gut 2005;54:1263–72.
    1. Camilleri M. Testing the sensitivity hypothesis in practice: tools and methods, assumptions and pitfalls. Gut 2002;51:i 34–40.
    1. Whitehead WE, Drinkwater D, Cheskin LJ, et al. Constipation in the elderly living at home. Definition, prevalence, and relationship to lifestyle and health status. J Am Geriatr Soc 1989;37:423–9.
    1. Chun AB, Sokol MS, Kaye WH, et al. Colonic and anorectal function in constipated patients with anorexia nervosa. Am J Gastroenterol 1997;92:1879–83.
    1. Hosseinzadeh ST, Poorsaadati S, Radkani B, et al. Psychological disorders in patients with chronic constipation. Gastroenterol Hepatol Bed Bench 2011;4:159–63.
    1. Sonnenberg A, Koch TR. Epidemiology of constipation in the United States. Dis Colon Rectum 1989;32:1–8.
    1. Rao SS, Seaton K, Miller MJ, et al. Psychological profiles and quality of life differ between patients with dyssynergia and those with slow transit constipation. J Psychosom Res 2007;63:441–9.
    1. Devroede G, Girand G, Bouchoucha M, et al. Idiopathic constipation by colonic dysfunction: relationship with personality and anxiety. Dig Dis Sci 1989;34:1428–33.
    1. Bytzer P, Howell S, Leemon M, et al. Low socioeconomic class is a risk factor for upper and lower gastrointestinal symptoms: a population based study in 15 000 Australian adults. Gut 2001;49:66–72.
    1. Wald A, Scarpignato C, Mueller-Lissner S, et al. A multinational survey of prevalence and patterns of laxative use among adults with self-defined constipation. Aliment Pharmacol Ther 2008;28:917–30.
    1. Sandler RS, Jordan MC, Shelton BJ. Demographic and dietary determinants of constipation in the US population. AmJ Public Health 1990;80:185–9.
    1. Howell SC, Quine S, Talley NJ. Low social class is linked to upper gastrointestinal symptoms in an Australian sample of urban adults. Scand J Gastroenterol 2006;41:657–66.
    1. Ludvigsson JF. Abis Study Group. Epidemiological study of constipation and other gastrointestinal symptoms in 8000 children. Acta Paediatr 2006;95:573–80.
    1. Inan M, Aydiner CY, Tokuc B, et al. Factors associated with childhood constipation. J Paediatr Child Health 2007;43:700–6.
    1. Ip KS, Lee WT, Chan JS, et al. A community-based study of the prevalence of constipation in young children and the role of dietaryfibre. Hong Kong Med J 2005;11:431–6.
    1. Pinto Sanchez MI, Bercik P. Epidemiology and burden of chronic constipation. Can J Gastroenterol 2011;25:11B–5B.
    1. Yost KJ, Haan MN, Levine RA, et al. Comparing SF-36 scores across three groups of women with different health profiles. Qual Life Res 2005;14:1251–61.
    1. Dennison C, Prasad M, Lloyd A, et al. The health-related quality of life and economic burden of constipation. Pharmacoeconomics 2005;23:461–76.
    1. Wald A. Constipation: advances in diagnosis and treatment. JAMA 2016;315:185–91.
    1. Rao SS, Go JT. Update on the management of constipation in the elderly: new treatment options. Clin Interv Aging 2010;5:163–71.
    1. Ford AC, Moayyedi P, Lacy BE, et al. Task Force on the Management of Functional Bowel Disorders. American College of Gastroenterology monograph on the management of irritable bowel syndrome and chronic idiopathic constipation. Am J Gastroenterol 2014;109suppl 1:S2–6.
    1. Saad RJ, Rao SSC, Koch KL, et al. Do stool form and frequency correlate with whole-gut and colonic transit? Results from a multicenter study in constipated individuals and healthy controls. Am J Gastroenterol 2010;105:403–11.
    1. Tantiphlachiva K, Rao P, Attaluri A, et al. Digital rectal examination is a useful tool for identifying patients with dyssynergia. Clin Gastroenterol Hepatol 2010;8:955–60.
    1. American Gastroenterological Association Medical Position Statement on Constipation. Gastroenterology 2013;144:211–7.
    1. Karlbom U, Lundin E, Graf W, et al. Anorectal physiology in relation to clinical subgroups of patients with severe constipation. Colorectal Dis 2004;6:343–9.
    1. Rao SS, Meduri K. What is necessary to Diagnose Constipation? Best Pract Res Clin Gastroenterol 2011;25:127–40.
    1. Tobon F, Reid NC, Talbert JL, et al. Nonsurgical test for the diagnosis of Hirschsprung's disease. Am J Gastroenterol 1968;278:188–93.
    1. Faussone-Pellegrini MS, Fociani P, Buffa R, et al. Loss of interstitial cells and a fibromuscular layer on the luminal side of the colonic circular muscle presenting as megacolon in an adult patient. Gut 1999;45:775–9.
    1. Rao SS, Welcher KD, Leistikow JS. Obstructive defecation: a failure of rectoanal coordination. Am J Gastroenterol 1998;93:1042–50.
    1. Bharucha AE. Editorial: identifying colonic motor dysfunction in chronic constipation with high-resolution manometry: pan-colonic pressurizations. Am J Gastroenterol 2017;112:490–2.
    1. Noelting J, Ratuapli SK, Bharucha AE, et al. Normal values for high-resolution anorectal manometry in healthy women: effects of age and significance of rectoanal gradient. Am J Gastroenterol 2012;107:1530–6.
    1. Rao SSC, Mudipalli RS, Stessman M, et al. Investigation of the utility of colorectal function tests and Rome II criteria in dyssynergic defecation (Anismus). Neurogastroenterol Motil 2004;16:589–96.
    1. Rao SSC, Ozturk R, Laine L. Clinical utility of diagnostic tests for constipation in adults: a systematic review. Am J Gastroenterol 2005;100:1605–15.
    1. Minguez M, Herreros B, Sanchiz V, et al. Pelvic floor dyssynergia in constipation. Gastroenterology 2004;126:57–62.
    1. Hsu CS, Liu TT, Yi CH, et al. Utility of balloon expulsion test in patients with constipation: preliminary results in a single center. Advances in Digestive Medicine 2016;34:181–6.
    1. Brandt LJ, Prather CM, Quigley EM, et al. Systematic review on the management of chronic constipation in North America. Am J Gastroenterol 2005;100:S5–21.
    1. Diamant NE, Kamm MA, Wald A, et al. AGA technical review on anorectal testing techniques. Gastroenterology 1999;116:735–60.
    1. Shorvon PJ, McHugh S, Diamant NE, et al. Defecography in normal volunteers: results and implications. Gut 1989;30:1737–49.
    1. Fletcher JG, Busse RF, Riederer SJ, et al. Magnetic resonance imaging of anatomic and dynamic defects of the pelvic floor in defecatory disorders. Am J Gastroenterol 2003;98:399–411.
    1. Thapar RB, Patankar RV, Kamat RD, et al. MR defecography for obstructed defecation syndrome. Indian J Radiol Imaging 2015;25:25–30.
    1. Rao SS. Advances in diagnostic assessment of fecal incontinence and dyssynergic defecation. Clin Gastroenterol Hepatol 2010;8:910–9.
    1. Kim ER, Rhee PL. How to Interpret a Functional or Motility Test - Colon Transit Study. J Neurogastroenterol Motil 2012;18:94–9.
    1. Saad RJ, Hasler WL. A technical review and clinical assessment of the wireless motility capsule. Gastroenterol Hepatol 2011;7:795–804.
    1. Rao SSC, Kuo B, McCallum RW. Investigation of colonic and whole gut transit with wireless motility capsule and radioopaque markers in constipation. Clin Gastroenterol Hepatol 2009;7:537–44.
    1. Lee A, Michalek W, Wiener SM, et al. T1067 clinical impact of a wireless motility capsule—a retrospective review. Gastroenterology 2010;138: S-481.
    1. Mueller-Lissner S, Kamm MA, Wald A. Multicenter, 4-week, double-blind, randomized, placebo-controlled trial of sodium picosulfate in patients with chronic constipation. Am J Gastroenterol 2010;105:897–903.
    1. Lacy BE, Levy LC. Lubiprostone: a novel treatment for chronic constipation. Clin Interv Aging 2008;3:357–64.
    1. Quigley EM. Prucalopride: safety, efficacy and potential applications. Therap Adv Gastroenterol 2012;5:23–30.
    1. Rodriguez RW. Off-label uses of alvimopan and methylnaltrexone. Am J Health Syst Pharm 2014;71:1450–5.
    1. Fateh R, Iravani S, Frootan M, et al. Synbiotic preparation in men suffering from functional constipation: a randomised controlled trial. Swiss Med Wkly 2011;141:w13239.
    1. Rao SSC. Biofeedback therapy for constipation in adults. Best practice & research. Clin Gastroenterol 2011;25:159–66.
    1. Remes-Troche JM, Paulson J, Yamada T, et al. Anorectal cortical function is impaired in patients with dyssynergic defecation. Gastroenterology 2007;108:A20.
    1. Dehghan FM, Frootan M, Javanbakhti M, et al. The effects of a physiotherapy program based on education and pelvic floor muscle training on chronic functional constipation. J Med Council Islamic Republic Iran 2013;30:400–7.
    1. Levitt MA, Mathis KL, Pemberton JH. Surgical treatment for constipation in children and adults. Best Pract Res Clin Gastroenterol 2011;25:167–79.
    1. Hassan I, Pemberton JH, Young-Fadok TM. Ileorectal anastomosis for slow transit constipation: long-term functional and quality of life results. J Gastrointest Surg 2006;10:1330–7.
    1. Gray JR. What is chronic constipation? Definition and diagnosis. Can J Gastroenterol 2011;25suppl B:7B–10B.
    1. Rao SS, Rattanakovit K, Patcharatrakul T. Diagnosis and management of chronic constipation in adults. Nat Rev Gastroenterol Hepatol 2016;13:295–305.

Source: PubMed

Patrocinadores e Colaboradores

Condições médicas

Intervenções de drogas

3
Se inscrever