Constipation (cont.)
When should I seek medical care for chronic constipation?
If the main problem is straining to push the stool out, chronic constipation should probably be evaluated early. This difficulty might be due to pelvic floor dysfunction, and the treatment of choice is biofeedback training, not laxatives. If the constipation is not responding to the simple measures discussed previously with the addition of hyper-osmolar laxatives or milk of magnesia, it is time to consult a physician for an evaluation. If a primary doctor is not comfortable performing the evaluation or does not have confidence in doing an evaluation, he or she should refer the patient to a gastroenterologist. Gastroenterologists evaluate constipation frequently and are very familiar with the diagnostic testing described previously.
What's new in the treatment of constipation?
Each part of
the intestine (stomach, small intestine, and colon) has a network of nerves
that controls its muscles. A great deal of research is being done in order
to gain an understanding of how these nerves control each other and ultimately the
muscles. Much of this research involves the study of neurotransmitters. (Neurotransmitters are
chemicals that nerves use to communicate with each
other.) This research is allowing scientists to develop drugs that stimulate
(and inhibit) the various nerves of the colon which, in turn, cause the muscles
of the colon to contract and propel the colonic contents. Such drugs have great
potential for the treatment of constipation that is due to colonic inertia. The
first of these drugs is in clinical trials and is likely to be available soon.
These drugs are an exciting development because they offer a new treatment for
a difficult-to-treat form of constipation.
Nevertheless, there are many questions
about these types of drugs that must be answered. How effective are they?
Will they work in many or only a few patients? Will they work in patients who
have damaged their nerves with stimulant laxatives? Since these medications are
likely to be used for a lifetime, how safe will they be with many years of use?
Will they be used indiscriminately in situations for which simple treatments
(for example, fiber) or more appropriate treatments (for example, biofeedback training) should
be used?
Constipation At A Glance
- Constipation is defined medically as fewer than three
stools per week and severe constipation as less than one stool per week.
- Constipation usually is caused by the slow movement of
stool through the colon.
- There are many causes of constipation including
medications, poor bowel habits, low fiber diets, abuse of laxatives, hormonal
disorders, and diseases primarily of other parts of the body that also affect
the colon.
- The two disorders limited to the colon that cause
constipation are colonic inertia and pelvic floor dysfunction.
- Medical evaluation for the cause of constipation
should be done when constipation is of sudden onset, severe, worsening,
associated with other worrisome symptoms such as loss of weight, or is not
responding to simple, safe treatments.
- Medical evaluation of constipation may include a
history, physical examination, blood tests, abdominal X-rays, barium enema,
colonic transit studies, defecography, ano-rectal motility studies, and
colonic motility studies.
- The goal of therapy for constipation is one bowel
movement every two to three days without straining.
- Treatment of constipation may include dietary fiber,
non-stimulant laxatives, stimulant laxatives, enemas, suppositories,
biofeedback training, and surgery.
- Stimulant laxatives should be used as a last
resort because of the possibility that they may permanently damage the colon and worsen
constipation.
- Most herbal laxatives contain stimulant-type laxatives and should be used, if at
all, as a last resort.
Last Editorial Review: 3/31/2009
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