Cited by 655Gastrointestinal motility and disordersPelvic floor disorders treatmentsCongenital gastrointestinal and neural anomalies

Mechanisms, evaluation, and management of chronic constipation

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Bharucha, Adil E., Lacy, Brian E.·2020·Gastroenterology

Abstract

With a worldwide prevalence of 15%, chronic constipation is one of the most frequent gastrointestinal diagnoses made in ambulatory medicine clinics, and is a common source cause for referrals to gastroenterologists and colorectal surgeons in the United States. Symptoms vary among patients; straining, incomplete evacuation, and a sense of anorectal blockage are just as important as decreased stool frequency. Chronic constipation is either a primary disorder (such as normal transit, slow transit, or defecatory disorders) or a secondary one (due to medications or, in rare cases, anatomic alterations). Colonic sensorimotor disturbances and pelvic floor dysfunction (such as defecatory disorders) are the most widely recognized pathogenic mechanisms. Guided by efficacy and cost, management of constipation should begin with dietary fiber supplementation and stimulant and/or osmotic laxatives, as appropriate, followed, if necessary, by intestinal secretagogues and/or prokinetic agents. Peripherally acting μ-opiate antagonists are another option for opioid-induced constipation. Anorectal tests to evaluate for defecatory disorders should be performed in patients who do not respond to over-the-counter agents. Colonic transit, followed if necessary with assessment of colonic motility with manometry and/or a barostat, can identify colonic dysmotility. Defecatory disorders often respond to biofeedback therapy. For specific patients, slow-transit constipation may necessitate a colectomy. No studies have compared inexpensive laxatives with newer drugs with different mechanisms. We review the mechanisms, evaluation, and management of chronic constipation. We discuss the importance of meticulous analyses of patient history and physical examination, advantages and disadvantages of diagnostic testing, guidance for individualized treatment, and management of medically refractory patients.

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Crossref · 10.1053/j.gastro.2019.12.034

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  • For prucalopride, the recommended dose is 2 mg once daily in adults and 1 mg daily in individuals with severe renal impairment (creatinine clearance <30 mL/min).

    “For prucalopride, a selective agonist of serotonin 5-HT 4 receptors, the recommended dose is 2 mg once daily in adults and 1 mg daily in individuals with severe renal impairment (ie, creatinine clearance &lt;30 mL/min). 80”

    From American Gastroenterological Association-American College of Gastroenterology Clinical Practice Guideline: Pharmacological Management of Chronic Idiopathic Constipation (2023) · cites this paper as [80]

    The Prokinetic and Other Agents section identifies prucalopride as a selective serotonin 5-HT4 agonist and says trials tested 1-mg and 2-mg doses. It does not state that 2 mg once daily is the recommended adult dose or that 1 mg daily is recommended for severe renal impairment (creatinine clearance <30 mL/min); searches for those dosing recommendations found no passage. (LLM, conf=0.82)

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  1. [88]Diamant NE, Kamm MA, Wald A, American Gastroenterological Association medical position statement on anorectal testing techniques. Gastroenterology 1999; 116: 732– 760. 10029631

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Authors
Bharucha, A. E., & Lacy, B. E.
Affiliations
Mayo Clinic (US)
Corresponding author
Bharucha, Adil E.
Venue
Gastroenterology
Publisher
Elsevier BV
Published
2020-04
Volume
158
Issue
5
Pages
1232-1249.e3
ISSN
0016-5085 (ISSN-L)
OpenAlex
W3000300599
Cited by
655
References
170
Citations by year
2026: 108 · 2025: 157 · 2024: 115 · 2023: 99 · 2022: 112 · 2021: 46 · 2020: 17 · 2013: 1
FWCI
11.88
Type
journal article
Language
en
Open access
Locations
  • Gastroenterology (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute of Diabetes and Digestive and Kidney Diseases
Topics
  • Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
  • Health Sciences › Medicine › Rheumatology › Pelvic floor disorders treatments
  • Health Sciences › Medicine › Surgery › Congenital gastrointestinal and neural anomalies
Keywords
chronic constipation, defecation disorders, slow transit constipation, colonic transit, colonic motility, pelvic floor dysfunction, dietary fiber supplementation, laxatives, prokinetic agents, opioid-induced constipation, biofeedback, anorectal manometry, barostat, colectomy, constipation treatment
MeSH terms
Secretagogues, Chronic Disease, Colon, Constipation, Defecation, Dietary Fiber, Electromyography, Gastrointestinal Motility, Humans, Intestinal Mucosa, Magnetic Resonance Imaging, Manometry, Rectum, Prevalence, Receptors, Opioid, mu, Pelvic Floor, Dietary Supplements, Defecography, Digital Rectal Examination, Laxatives

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