Bowel Health: Managing Chronic Constipation

By Madhulika Varma, MD Chief of Colorectal Surgery and an Associate Professor of Surgery at the University of California, San Francisco

Dr. Varma has disclosed that she has no financial interests related to this topic.

With 4.4 million individuals in the United States suffering from constipation and 2.5 million office visits per year dedicated to treating it, a standardized approach to assessment and treatment is needed to optimize patient outcome.

Constipation manifests through two varying mechanisms: obstructive defecation and slow transit constipation. Regardless of the source, the vast majority of all patients suffering from constipation respond well to conservative therapies including changes in diet and use of mild laxatives.

For individuals whose constipation is unique, it is valuable to consider irritable bowel syndrome (IBS) as an underlying cause. While complex relationships exist between IBS and psychosocial factors, motility, visceral sensitivity, and life stress, it is possible that IBS is a result of small intestinal bacterial overgrowth (SIBO). A comprehensive approach to IBS treatment incorporates diet modifications, stress reduction, and treatment for diarrhea and constipation, which may include an assessment of pelvic floor function.

Individuals whose constipation does not respond to conservative treatment, or who exhibit debilitating symptoms, may benefit from pelvic physiology testing. The ability of pelvic physiology testing to ascertain outlet obstruction, colonic inertia, and puborectalis function makes it a particularly valuable tool for individuals whose constipation is not genetic. A standardized approach to assessing the constipation source enables clinicians to effectively diagnose its origin and prescribe effective treatment.