Motility Disorders Constipation Constipation—Recent Advances in Treatment Amer A Alkhatib, MD1 and Ashok K Tuteja, MD, MRCP (UK), MPH2
1. Gastroenterology Fellow, Division of Gastroenterology and Hepatology, The George E Wahlen Veterans Affairs Medical Center University of Utah School of Medicine; 2. Adjunct Assistant Professor, The Pharmacy College, Washington State University
Abstract
Constipation is a common disorder that affects up to 27% of people in developed countries. Constipation is not a single disease but a combination of symptoms due to impairments in colonic and anorectal function. The goal of treatment in constipation is to ensure a complete spontaneous and satisfied bowel movement and improve quality of life. However, mostly patients learn to cope with their symptoms and are often dissatisfied with existing treatments. This article discusses the recent advances in the management of constipation.
Keywords
Constipation, management, prucalopride, renzapride, mosapride, lubiprostone, methylnaltrexone, alvimopan, linaclotide, probiotics, botulinum type-A toxin, biofeedback
Disclosure: Amer A Alkhatib, MD, has no conflicts of interest to declare. Ashok K Tuteja, MD, MRCP (UK), MPH, has grant support from Forest Pharmaceuticals. He is on the advisory panel of Sucampo Pharmaceuticals and Wyeth. Received: June 11, 2010 Accepted: October 20, 2010 Citation: US Gastroenterology & Hepatology Review, 2010;6:43–7 Correspondence: Ashok K Tuteja, MD, MRCP (UK), MPH, Associate Professor of Medicine, Division of Gastroenterology, George E Wahlen Veterans Affairs Medical Center and University of Utah, Salt Lake City, Utah. E:
Ashok.tuteja@hsc.utah.edu
Constipation is a common medical disorder encountered by primary care providers, hospitals, and gastroenterologists.1
a mild symptom that responds well to lifestyle modification and dietary modifications, but it can also be a difficult clinical condition requiring multidrug use and even hospitalization and surgical intervention.2
The goal of treatment in constipation is to ensure a complete spontaneous and satisfied bowel movement and improve quality of life.3
However,
most patients learn to cope with their symptoms and are often dissatisfied with existing treatments. This article will focus on recent advances in the treatment of constipation.
Epidemiology
Constipation is a common medical problem leading to more than 2.5 million visits to physicians and 92,000 hospitalizations in the US.4
Almost
The economic impact of constipation is estimated to be several hundred millions of dollars annually.6 people in developed countries.4,7,8 men,9
all the physician visits (85%) for constipation result in a prescription for a laxative.5
non-whites more than whites,10 the elderly more than younger adults.10
Constipation affects up to 27% of Constipation affects women more than children more than adults,11 Other risk factors for constipation
and
Subjects with self-reported constipation also report significantly lower quality of scores in all domains of the Short Form (36) Health Survey (SF-36®) survey.15
include low income, history of sexual abuse, and depression.12 Constipation has been associated with low general wellbeing and with depression.13,14
© TOUCH BRIEFINGS 2010
Constipation can be
There is disparity among patients and physicians in defining constipation. Usually physicians think of constipation as infrequent bowel movements. Most patients complain of constipation if they have one or more of the following symptoms: hard stools, infrequent defecation, the need of excessive straining, sensation of incomplete evacuation, prolonged time spent on the toilet, or unsuccessful defecation.12,16
The Rome criteria
were introduced to establish a uniform definition of constipation (see Table 1).7
Causes and Pathophysiology Constipation is usually multifactorial.2
It can be precipitated by systemic,
Primary chronic constipation has been divided into three pathophysiologic subtypes: slow-transit constipation, normal-transit constipation, and pelvic floor dyssynergia (PFD)-type constipation. This includes disorders of rectal evacuation or defecation and dyssynergic defecation.2
neurologic , hormonal, or anatomic disorders. Constipation is a common side effect of many medications. In functional chronic constipation or primary constipation there are no structural, biochemical, or physiologic abnormalities.7
PFD is also known as obstructed defecation, outlet obstruction, or anismus.17
Slow-transit constipation is best diagnosed by measuring colonic transit time. Stool frequency is decreased in this type of constipation.2 PFD or dyssynergic defecation is due to a lack of coordination between the abdominal, rectoanal, and pelvic floor muscles during defecation, which leads to an inability to defecate. This condition often results in
43
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76 |
Page 77 |
Page 78 |
Page 79 |
Page 80 |
Page 81 |
Page 82 |
Page 83 |
Page 84 |
Page 85 |
Page 86 |
Page 87 |
Page 88 |
Page 89 |
Page 90 |
Page 91 |
Page 92 |
Page 93 |
Page 94 |
Page 95 |
Page 96 |
Page 97 |
Page 98 |
Page 99 |
Page 100