Evaluation and management of constipation

Abstract

Constipation is a common clinical problem. The evaluation and management of most patients are within the capability of interested, well-trained primary care physicians. The diagnostic evaluation includes an adequate history to exclude treatable etiologies, anatomic evaluation of the colon, and functional studies in refractory patients. Treatment options include medication adjustment and associated disease treatment, followed by a trial of daily fiber or laxatives. Appropriate patients should be referred for consideration of surgical treatment, which usually involves a colectomy and ileoproctostomy for colonic inertia.

Keywords: Colectomy; colonic inertia; constipation; outlet obstruction.

Figure 1. Transit study. Abdominal radiograph taken on day 1 with 24 markers distributed throughout the colon.