Constipation is one of the most common digestive conditions in the United States, affecting both outpatient centers and leading to referrals to gastroenterologists and colorectal surgeons. It is characterized by difficult or infrequent evacuation of stools, hardness of stools, or a feeling of incomplete evacuation. Constipation can be divided, with considerable overlap, into stool consistency problems (hard and painful stools) and defecatory behavior problems (infrequency, difficulty evacuating, straining during defecation).When it comes to treating rectal evacuation disorders associated with constipation, there are several options available. The first step is to increase dietary fiber intake to a goal of 30 to 40 grams per day and increase water intake to more than 2 liters per day.
Additionally, stool softeners or laxatives, home enemas, and colonic irrigation can be used. It is important to note that some agents (e.g., phosphate, bran, cellulose) bind to drugs and interfere with absorption. Rapid fecal transit may carry some medications and nutrients beyond their optimal absorption site. Contraindications for the use of laxatives and cathartics include acute abdominal pain of unknown origin, inflammatory bowel disorders, intestinal obstruction, gastrointestinal bleeding, and fecal retention. Endocrinological and metabolic disorders such as hypercalcemia, hyperparathyroidism, hypokalemia, hypothyroidism, pregnancy and diabetes mellitus can also cause constipation. The treatment of dysinergic defecation consists of standard treatment for constipation (biofeedback therapy) and other measures such as botulinum toxin injection, myectomy or ileostomy.
Anorectal tests should be used to evaluate defecation disorders if over-the-counter agents do not relieve constipation. Improving reimbursement for this treatment will have a significant impact and could be transformative for patients with this common form of constipation. Minilaparotomy with a laparoscopically assisted procedure without gas by lifting the abdominal wall for ileoretal anastomosis in patients with slow-moving constipation is also an option. Changes in rectal and anal sphincter pressure and manometric patterns in a patient with constipation and dysinergic defecation can be evaluated before and after biofeedback therapy. In conclusion, there are several treatments available for rectal evacuation disorders associated with constipation. Increasing dietary fiber intake and water intake are the first steps in treating this condition.
Additionally, stool softeners or laxatives, home enemas, colonic irrigation, botulinum toxin injection, myectomy or ileostomy can be used. Improving reimbursement for this treatment will have a significant impact on patients with this common form of constipation.