Review article: diagnosis, management and patient perspectives of the spectrum of constipation disorders

Amol Sharma, Satish S C Rao, Kimberly Kearns, Kimberly D Orleck, Scott A Waldman, Amol Sharma, Satish S C Rao, Kimberly Kearns, Kimberly D Orleck, Scott A Waldman

Abstract

Background: Chronic constipation is a common, heterogeneous disorder with multiple symptoms and pathophysiological mechanisms. Patients are often referred to a gastroenterology provider after laxatives fail. However, there is limited knowledge of the spectrum and management of constipation disorders.

Aim: To discuss the latest understanding of the spectrum of constipation disorders, tools for identifying a pathophysiologic-based diagnosis in the specialist setting, treatment options and the patient's perspective of constipation.

Methods: Literature searches were conducted using PubMed for constipation diagnostic criteria, diagnostic tools and approved treatments. The authors provided insight from their own practices.

Results: Clinical assessment, stool diaries and Rome IV diagnostic criteria can facilitate diagnosis, evaluate severity and distinguish between IBS with constipation, chronic idiopathic constipation and dyssynergic defecation. Novel smartphone applications can help track constipation symptoms. Rectal examinations, anorectal manometry and balloon expulsion, assessments of neuromuscular function with colonic transit time and colonic manometry can provide mechanistic understanding of underlying pathophysiology. Treatments include lifestyle and diet changes, biofeedback therapy and pharmacological agents. Several classes of laxatives, as well as prokinetic and prosecretory agents, are available; here we describe their mechanisms of action, efficacy and side effects.

Conclusions: Constipation includes multiple overlapping subtypes identifiable using detailed history, current diagnostic tools and smartphone applications. Recognition of individual subtype(s) could pave the way for optimal, evidence-based treatments by a gastroenterology provider.

© 2021 The Authors. Alimentary Pharmacology & Therapeutics published by John Wiley & Sons Ltd.

Figures

FIGURE 1
FIGURE 1
Bristol Stool Form Scale. Copyright 2000 © by Rome Foundation. All Rights Reserved
FIGURE 2
FIGURE 2
Parameters in Constipation Stool Diary in constipated and healthy subjects. This figure has been reproduced from Yan et al Gastroenterology 2020 with permission from Elsevier. 25 BM, bowel movement; CSBM, complete spontaneous bowel movement
FIGURE 3
FIGURE 3
Mechanism of action of agents used for the treatment of constipation. This figure has been modified from Simrén et al Nature Reviews Gastroenterology & Hepatology 2018 with permission from Springer Nature Customer Service GmBH: Wiley. 171 ACh, acetylcholine; CFTR, cystic fibrosis transmembrane conductance regulator; ClC‐2, type‐2 chloride channel; GC‐C, guanylate cyclase‐C; IBAT, ileal bile acid transporter; NHE3, sodium/hydrogen exchanger 3; VIP, vasoactive intestinal polypeptide
FIGURE 4
FIGURE 4
Management algorithm for the treatment of constipation. This figure has been modified from Sharma Handb Exp Pharmacol. 2017 with permission by Springer Nature Customer Service GmBH: Wiley. 4 Mg, magnesium; PEG, polyethylene glycol; WMC, wireless motility capsule

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