What is it?
Chronic constipation is a functional disorder of the intestinal tract in which, in the absence of organic lesions, a feeling of difficulty, infrequent or incomplete emptying prevails. Women and the elderly suffer the most. Chronic constipation can be divided into a primary form, or functional constipation, when no specific cause is identified, and a secondary form when it is caused by a chronic illness, medication or mechanical obstruction. Chronic functional constipation can be divided into three subcategories: constipation with normal bowel transit, constipation with slow bowel transit, and constipation caused by impaired coordination of the abdominal and rectal muscles responsible for evacuation.
Which are the symptoms?
Symptoms must appear at least 6 months before diagnosis, last at least 3 months, and include at least 2 or more of the following criteria:
- efforts at evacuation in more than 25% of evacuations
- small, hard stool in more than 25% of evacuations
- frequency of less than 3 evacuations per week (without laxatives)
- feeling of anal obstruction/blockage in more than 25% of evacuations
- feeling of incomplete evacuation in more than 25% of evacuations
- manual maneuvers that promote defecation in more than 25% of evacuations
Abdominal pain and bloating may be present but are not predominant symptoms, so irritable bowel syndrome should be ruled out.
How is it diagnosed?
The diagnosis of chronic constipation should be based on medical history, patient visit, laboratory tests, colonoscopy if indicated, and specific tests assessing bowel motility if necessary (transit with radioisotope markers, defecography, anorectal manometry, electromyography, test assessing the latency of the pudendal nerve).
How is it treated?
The treatment requires the following:
- exclusion of drugs that can cause constipation;
- eating more plant fiber;
- abundant hydration (at least 2 liters per day);
- regular and constant physical activity.
When necessary, medical enemas can be used.
The use or abuse of herbs or classic over-the-counter laxatives is not indicated. In some cases, they may even be counterproductive, exacerbating the symptom.
In cases of abdominopelvic dyssynergia, pelvic floor rehabilitation (biofeedback) is recommended to strengthen and better coordinate the muscles involved during defecation.
Where do we treat it?
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