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2017 ; 5
(4
): 465-472
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Management of chronic constipation in adults
#MMPMID28588875
Krogh K
; Chiarioni G
; Whitehead W
United European Gastroenterol J
2017[Jun]; 5
(4
): 465-472
PMID28588875
show ga
Chronic constipation (CC) is an extremely common condition with an estimated
prevalence of up to 24%. Most patients with CC should be treated in primary care.
Changes in lifestyle, including increased intake of dietary fibre, fluid, and
exercise, should be attempted in most patients. Osmotic or stimulant laxatives
are indicated if there are insufficient effects of lifestyle changes. Prokinetics
and secretagogues should be restricted to those not responding to basic
treatment. Anorectal physiology tests and assessment of colorectal transit time
are indicated if medical treatment fails or if symptoms indicate severely
obstructed defecation. If symptoms indicate an underlying structural disorder,
barium or magnetic resonance evacuation proctography is indicated. Biofeedback
therapy is effective in patients with dyssynergic defecation. In patients with
other evacuation disorders, rectally administered laxatives or transanal
irrigation should be attempted. Surgery is restricted to the minority of CC
patients with very severe symptoms not responding to conservative treatment.
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