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CONSTIPATION IN ADULTS - CHRONIC FUNCTIONAL
Constipation is an unsatisfactory defecation distinguished by difficult stool passage, infrequent stools or both.
Difficult stool passage may include straining, feeling of difficulty in passing stool, incomplete evacuation, lumpy/hard stools, prolonged time to defecate, need for manual maneuver to pass stool, abdominal discomfort and feeling of anorectal blockade.
Chronic constipation is considered when symptoms of constipation have existed ≥3 months.
Symptoms of chronic constipation may be due to dysfunction of intestinal motility, visceral sensitivity, anorectal musculature or the enteric nervous system.

Surgical Intervention

  • A surgical referral may be considered for treatment of constipation (evacuation disorder, slow transit constipation) if patient is unresponsive after prolonged trial of nonsurgical measures and if symptoms affect activities of daily living
    • Effective in relieving constipation is a subtotal colectomy with ileorectostomy with a laparoscopic colectomy obtaining similar success rate but less morbidity than an open colectomy
    • A rectovaginal repair or rectal suspension may be considered for a rectocele or rectal prolapse
  • Patients with functional constipation should have a formal psychiatric and upper gastrointestinal motility evaluation with small intestine transit time measurement before undergoing surgery
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