Behavioural and new pharmacological treatments for constipation: getting the balance right (original) (raw)
Recent advances in clinical practice
Behavioural and new pharmacological treatments for constipation: getting the balance right
- Michael Camilleri,
- Adil E Bharucha
- Clinical Enteric Neuroscience Translational and Epidemiological Research (CENTER), Mayo Clinic, Rochester, Minnesota, USA
- Correspondence to Dr Michael Camilleri, Mayo Clinic, Charlton 8-110, 200 First St. S.W., Rochester, MN 55905, USA; camilleri.michael{at}mayo.edu
Abstract
Chronic constipation affects almost one in six adults and is even more frequent in the elderly. In the vast majority of patients, there is no obstructive mucosal or structural cause for constipation and, after excluding relatively rare systemic diseases (commonest of which is hypothyroidism), the differential diagnosis is quickly narrowed down to three processes: evacuation disorder of the spastic (pelvic floor dyssynergia, anismus) or flaccid (descending perineum syndrome) varieties, and normal or slow transit constipation. Treatment of chronic constipation based on identifying the underlying pathophysiology is generally successful with targeted therapy. The aims of this review are to discuss targeted therapy for chronic constipation: behavioural treatment for outlet dysfunction and pharmacological treatment for constipation not associated with outlet dysfunction. In particular, we shall review the evidence that behavioural treatment works for evacuation disorders, describe the new treatment options for constipation not associated with evacuation disorder, and demonstrate how ‘targeting therapy’ to the underlying diagnosis results in a balanced approach to patients with these common disorders.
- Constipation
- rectal evacuation disorder
- anal and pelvic floor biofeedback therapy
- colonic diseases
- pharmacotherapy
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