Constipation of anorectal outlet obstruction: pathophysiology, evaluation and management.

Full Abstract

Constipation is a subjective symptom of various pathological conditions. Incidence of constipation fluctuates from 2 to 30% in the general population. Approximately 50% of constipated patients referred to tertiary care centers have obstructed defecation constipation. Constipation of obstructed defecation may be due to mechanical causes or functional disorders of the anorectal region. Mechanical causes are related to morphological abnormalities of the anorectum (megarectum, rectal prolapse, rectocele, enterocele, neoplasms, stenosis). Functional disorders are associated with neurological disorders and dysfunction of the pelvic floor muscles or anorectal muscles (anismus, descending perineum syndrome, Hirschsprung's disease). However, this type of constipation should be differentiated by colonic slow transit constipation which, if coexists, should be managed to a second time. Assessment of patients with severe constipation includes a good history, physical examination and specialized investigations (colonic transit time, anorectal manometry, rectal balloon expulsion test, defecography, electromyography), which contribute to the diagnosis and the differential diagnosis of the cause of the obstructed defecation. Thereby, constipated patients can be given appropriate treatment for their problem, which may be conservative (bulk agents, high-fiber diet or laxatives), biofeedback training or surgery.

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Author information

Author/s: Andromanakos, Nikolaos (N); Skandalakis, Panayiotis (P); Troupis, Theodoros (T); Filippou, Dimitrios (D);

Affiliation: Second Department of Propedeutic Surgery, Athens University Medical School, Laiko General Hospital, Athens, Greece.

Journal and publication information

Publication Type: Journal Article; Review

Journal: Journal of gastroenterology and hepatology (J Gastroenterol Hepatol), published in Australia. (Language: eng)

Reference: 2006-Apr; vol 21 (issue 4) : pp 638-46

Dates: Created 2006/05/08; Completed 2006/10/12; Revised 2007/11/15;

PMID: 16677147, status: MEDLINE (last retrieval date: 12/26/2008)

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Anus Diseases - complications; diagnosis; therapy
Biofeedback (Psychology) - methods
Constipation - diagnosis; etiology; therapy
Diagnosis, Differential
Diet Therapy - methods

Humans
Intestinal Obstruction - complications; diagnosis; therapy
Physician's Practice Patterns
Practice Guidelines as Topic
Rectal Diseases - complications; diagnosis; therapy

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