Recommendations Issued for Managing Chronic Constipation

FRIDAY, Sept. 13, 2024 (HealthDay News) — Recommendations have been developed to address evaluation and management of chronic constipation, according to updated American Society of Colon and Rectal Surgeons guidelines published in the October issue of Diseases of the Colon & Rectum.

Karim Alavi, M.D., M.P.H., from UMass Memorial Medical Center in Worcester, Massachusetts, and colleagues developed guidelines for evaluation and management of chronic constipation.

The authors present six strong recommendations and seven conditional recommendations. The strong recommendations include a directed history and physical examination for patients presenting with constipation. Dietary modifications and ensuring adequate fluid intake and fiber supplementation comprise initial management of patients with symptomatic constipation. To manage chronic constipation, osmotic laxatives are appropriate first-line medical therapy; if necessary, stimulant laxatives can be considered for rescue therapy or as second-line therapy. Before surgical intervention is considered, colonic motility and transit should be measured. For patients with symptomatic pelvic floor dyssynergia, biofeedback therapy is considered a first-line treatment. Due to the high complication rates associated with the procedure, stapled transanal rectal resection is not recommended for the repair of a rectocele or internal rectal intussusception.

“The complex cause and variable severity of constipation symptoms mandate an individualized approach to evaluation and treatment,” the authors wrote. “Given the range of specialties that manage constipation, a collaborative approach is often warranted to achieve optimal patient outcomes.”

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