Last update:
08-Mar-2007

Constipation is a subjective symptom of various diseases and mechanisms. The symptoms of severe constipation may include incomplete, prolonged, difficult, rare or painful defecation, abdominal pain and bloating. In epidemiological studies, the incidence of constipation is determined to be 2-30% in the general population, more frequent in women, and with an increase in relation to age. Chronic severe constipation may be due to extraintestinal or intestinal causes. If a specific cause of chronic constipation, extraintestinal or colonic (organic or anatomic), is not identified, constipation can be considered an idiopathic disorder. Idiopathic constipation is classified into colonic slow-transit constipation (colonic dysmotility) and constipation of obstructed defecation (anorectal outlet obstruction or anorectal dysmotility). Constipation of obstructed defecation may be due to mechanical causes or to 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 disorder and dysfunction of the pelvic floor muscles or anorectal muscles (anismus, descending perineum syndrome, Hirschsprung's disease). However, two causes of idiopathic constipation may coexist, most commonly, colonic slow-transit combined with anismus. Assessment of the patient with severe constipation includes a good history, physical examination and specialized investigations (colonic transit time, anorectal manometry, rectal balloon expulsion test, defecography, electromyography), which may contribute to the diagnosis and the differential diagnosis of the cause of idiopathic constipation. In this way, constipated patients can be given causative treatment of their problem, which may be conservative (bulk agents, high-fiber diet or laxatives), biofeedback training or surgery. Surgical treatment is considered when the medical therapy has failed. Its results are very good after a thorough assessment of patients, particularly for colonic slow-transit constipation (partial or total colectomy), but also for rectal prolapse, rectal mucosa prolapse and large rectocele.

Key words: Anorectal outlet obstruction, Chronic constipation, Colonic slow-transit constipation, Idiopathic constipation, Obstructive defecation.