Med. Pro Praxi 2009; 6(1): 6-13

Constipation - current approach to diagnosis and treatment

MUDr. Jan Martínek Ph.D

Interní klinika 1. LF UK a ÚVN Praha

Primary constipation is divided into slow transit constipation and terminal constipation. Patients with terminal constipation have difficulties

emptying their bowel. If it is caused by a paradox contraction of the pelvic floor and sphincter muscles, it is referred to as anismus.

If terminal constipation results from an anatomical obstruction, it is referred to as obstructed defecation syndrome (ODS). Anismus is

managed with physiotherapy, ODS is managed surgically. In patients with slow transit constipation, bowel transit time is increased.

Currently, the only available treatment for severe constipation frequently is long-term use of laxatives. There is a myth concerning stimulatory

laxatives such as Guttalax® that they are harmful; however, no harmful effects have been proved. These laxatives are effective

and safe even for long-term use. Hyperosmolar solutions or lactulose may also be used as laxatives.

Subtotal colectomy is an alternative treatment in patients with lazy bowel syndrome. Basic investigations in patients with constipation

include bowel transit time test, defecography, and anorectal manometry.

Keywords: constipation, lazy bowel, anismus, laxatives, biofeedback

Published: March 1, 2009  Show citation