Constipation in ulcerative colitis: pathophysiology and practical management

Abstract

Clinical experience suggests that there is a cohort of patients with refractory colitis who do have faecal stasis that contributes to symptoms. The underlying physiology is poorly understood, partly because until recently the technology to examine segmental colonic motility has not existed. Patients are given little information on how proximal faecal stasis can complicate colitis. Treatment guidelines are scanty and many patients are offered little apart from laxatives and advice on increasing fibre intake, which often makes symptoms worse. This article aims to review the history, pathology and management, and create impetus for future research on this underappreciated condition.

Keywords: constipation; inflammatory bowel disease; ulcerative colitis.

Figure 1

Outline of diagnostic differentials and management considerations in the management of ulcerative colitis-associated constipation (UCAC). *Treatment escalation may be avoidable with treatment of symptomatic UCAC. **A trial of reduced fibre intake is also a consideration based on our centres experience.