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

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Mechanisms, Evaluation, and Management of Chronic Constipation

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

DOI 10.1053/j.gastro.2019.12.034PMC PMC7573977

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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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Diamant, 1999, American Gastroenterological Association medical position statement on anorectal testing techniques, Gastroenterology, 116, 732, 10.1016/S0016-5085(99)70194-0 · DOI

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American Gastroenterological Association-American College of Gastroenterology Clinical Practice Guideline: Pharmacological Management of Chronic Idiopathic Constipation
Chang, L., Chey, W. D., Imdad, A., Almario, C. V., Bharucha, A. E., Diem, S., Greer, K. B., Hanson, B., Harris, L. A., Ko, C., et al. (2023) · Gastroenterology · doi:10.1053/j.gastro.2023.03.214 · Cited by 185
Self-citation
ACG Clinical Guidelines: Management of Benign Anorectal Disorders
Wald, A. M., Bharucha, A. E., Limketkai, B. N., Malcolm, A., Remes-Troche, J. M., Whitehead, W. E., & Zutshi, M. (2021) · The American Journal of Gastroenterology · doi:10.14309/ajg.0000000000001507 · Cited by 166
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The enteric nervous system in gastrointestinal disease etiology
Holland, A. M., Bon‐Frauches, A. C., Keszthelyi, D., Melotte, V., & Boesmans, W. (2021) · Cellular and Molecular Life Sciences · doi:10.1007/s00018-021-03812-y · Cited by 172
“This is also the case for slow transit constipation, defined by reduced and infrequent intestinal transit, sensation of anorectal obstruction and solid fecal content [94].”
Background
Crosstalk between the gut microbiome and colonic motility in chronic constipation: potential mechanisms and microbiota modulation
Pan, R., Wang, L., Xu, X., Chen, Y., Wang, H., Wang, G., Zhao, J., & Chen, W. (2022) · Nutrients · doi:10.3390/nu14183704 · Cited by 149
“However, the aetiology and pathophysiology of CC are largely unknown [2].”
Background
Understanding the physiology of human defaecation and disorders of continence and evacuation
Heitmann, P. T., Vollebregt, P. F., Knowles, C. H., Lunniss, P. J., Dinning, P. G., & Scott, S. M. (2021) · Nature Reviews Gastroenterology & Hepatology · doi:10.1038/s41575-021-00487-5 · Cited by 156

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Authors: Bharucha, A. E., & Lacy, B. E.
Affiliations: Mayo Clinic (US)
Corresponding author: Bharucha, Adil E.
ORCID: Bharucha, Adil E.
Lacy, Brian E.
Venue: Gastroenterology
Publisher: Elsevier BV
Published: 2020-04
Volume: 158
Issue: 5
Pages: 1232-1249.e3
ISSN: 0016-5085 (ISSN-L)
DOI: 10.1053/j.gastro.2019.12.034
PMC: PMC7573977
OpenAlex: W3000300599
Cited by: 655
References: 170
Citations by year: 2026: 108 · 2025: 157 · 2024: 115 · 2023: 99 · 2022: 112 · 2021: 46 · 2020: 17
FWCI: 11.88
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
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 › Urology › 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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Mechanisms, Evaluation, and Management of Chronic Constipation

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