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Diagnosis and management of chronic constipation in adults
Abstract
Constipation is a heterogeneous, polysymptomatic, multifactorial disease. Acute or transient constipation can be due to changes in diet, travel or stress, and secondary constipation can result from drug treatment, neurological or metabolic conditions or, rarely, colon cancer. A diagnosis of primary chronic constipation is made after exclusion of secondary causes of constipation and encompasses several overlapping subtypes. Slow-transit constipation is characterized by prolonged colonic transit in the absence of pelvic floor dysfunction. This subtype of constipation can be identified using either the radio-opaque marker test or wireless motility capsule test, and is best treated with laxatives such as polyethylene glycol or newer agents such as linaclotide or lubiprostone. If unsuccessful, subspecialist referral should be considered. Dyssynergic defecation results from impaired coordination of rectoanal and pelvic floor muscles, and causes difficulty with defecation. The condition can be identified using anorectal manometry and balloon expulsion tests and is best managed with biofeedback therapy. Opioid-induced constipation is an emerging entity, and several drugs including naloxegol, methylnaltrexone and lubiprostone are approved for its treatment. In this Review, we provide an overview of the burden and pathophysiology of chronic constipation, as well as a detailed discussion of the available diagnostic tools and treatment options.
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“many risk factors of FC including age, diet, obesity, and stress have a large impact on the gut microbiota [ 33–35 ]”
From Role of gut microbiota in functional constipation (2021) · cites this paper as [35]
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Metadata
- Authors
- Rao, S. S. C., Rattanakovit, K., & Patcharatrakul, T.
- Affiliations
- Augusta University (US)
- Corresponding author
- Rao, Satish S. C.
- Venue
- Nature Reviews Gastroenterology & Hepatology
- Published
- 2016-04-01
- Volume
- 13
- Issue
- 5
- Pages
- 295-305
- ISSN
- 1759-5045 (ISSN-L)
- 1759-5053
- OpenAlex
- W2333706939
- Cited by
- 337
- References
- 112
- Citations by year
- 2026: 34 · 2025: 40 · 2024: 45 · 2023: 38 · 2022: 39 · 2021: 38 · 2020: 37 · 2019: 22 · 2018: 18 · 2017: 21 · 2016: 5
- FWCI
- 3.68
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Nature Reviews Gastroenterology & Hepatology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- American Neurogastroenterology and Motility Society
- Topics
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
- Health Sciences › Medicine › Urology › Pelvic floor disorders treatments
- Health Sciences › Medicine › Surgery › Congenital gastrointestinal and neural anomalies
- Keywords
- chronic constipation, secondary constipation, slow transit constipation, dyssynergic defecation, opioid-induced constipation, anorectal manometry, balloon expulsion test, biofeedback, laxatives, linaclotide, lubiprostone, naloxegol, methylnaltrexone, constipation pathophysiology
- MeSH terms
- Acute Disease, Adult, Algorithms, Biofeedback, Psychology, Cathartics, Chronic Disease, Colectomy, Constipation, Dietary Fiber, Nonprescription Drugs, Transcutaneous Electric Nerve Stimulation, Gastrointestinal Transit, Humans, Lumbosacral Plexus, Manometry, Medical Records, Risk Factors, Serotonin Agents, Irritable Bowel Syndrome, Digital Rectal Examination, Laxatives
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