The Approach to Diagnosis and Treatment of Chronic Constipation: Suggestions for a General Practitioner
Chronic constipation is a frequent complaint. Symptoms of obstructive defecation (straining, hard and lumpy stools, or incomplete evacuation) are more frequent and bothersome than the frequency of bowel movements. Patient assessment is clinically based on the presence or absence of red flags. Common...
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| Format: | Article |
| Language: | English |
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Wiley
2011-01-01
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| Series: | Canadian Journal of Gastroenterology |
| Online Access: | http://dx.doi.org/10.1155/2011/484836 |
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| author | Pierre Paré |
| author_facet | Pierre Paré |
| author_sort | Pierre Paré |
| collection | DOAJ |
| description | Chronic constipation is a frequent complaint. Symptoms of obstructive defecation (straining, hard and lumpy stools, or incomplete evacuation) are more frequent and bothersome than the frequency of bowel movements. Patient assessment is clinically based on the presence or absence of red flags. Commonly used therapies (eg, bulk-forming agents, stool softeners and stimulant laxatives) have only been evaluated in small studies of short duration. Polyethylene glycol was shown to be effective and safe in several rigorous trials with durations of more than one year. New drugs (prucalopride, lubiprostone and linaclotide) were shown to be effective and safe in well-designed and rigorous studies. Trials conducted in primary care patients are lacking for all therapies. Biofeedback and behavioural therapies are effective, but should be reserved for selected patients after proper diagnostic evaluation. A practical management algorithm is proposed using a multistep approach favouring early introduction of combined therapies and long-term step-down strategy to the lowest satisfactory regimen. |
| format | Article |
| id | doaj-art-722dbdc3ae1f48ab829005a4d54c9da2 |
| institution | Kabale University |
| issn | 0835-7900 |
| language | English |
| publishDate | 2011-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Canadian Journal of Gastroenterology |
| spelling | doaj-art-722dbdc3ae1f48ab829005a4d54c9da22025-08-20T03:33:43ZengWileyCanadian Journal of Gastroenterology0835-79002011-01-0125Suppl B36B40B10.1155/2011/484836The Approach to Diagnosis and Treatment of Chronic Constipation: Suggestions for a General PractitionerPierre Paré0Laval University, CHAUQ, Hôpital du St-Sacrement, Quebec City, Quebec, CanadaChronic constipation is a frequent complaint. Symptoms of obstructive defecation (straining, hard and lumpy stools, or incomplete evacuation) are more frequent and bothersome than the frequency of bowel movements. Patient assessment is clinically based on the presence or absence of red flags. Commonly used therapies (eg, bulk-forming agents, stool softeners and stimulant laxatives) have only been evaluated in small studies of short duration. Polyethylene glycol was shown to be effective and safe in several rigorous trials with durations of more than one year. New drugs (prucalopride, lubiprostone and linaclotide) were shown to be effective and safe in well-designed and rigorous studies. Trials conducted in primary care patients are lacking for all therapies. Biofeedback and behavioural therapies are effective, but should be reserved for selected patients after proper diagnostic evaluation. A practical management algorithm is proposed using a multistep approach favouring early introduction of combined therapies and long-term step-down strategy to the lowest satisfactory regimen.http://dx.doi.org/10.1155/2011/484836 |
| spellingShingle | Pierre Paré The Approach to Diagnosis and Treatment of Chronic Constipation: Suggestions for a General Practitioner Canadian Journal of Gastroenterology |
| title | The Approach to Diagnosis and Treatment of Chronic Constipation: Suggestions for a General Practitioner |
| title_full | The Approach to Diagnosis and Treatment of Chronic Constipation: Suggestions for a General Practitioner |
| title_fullStr | The Approach to Diagnosis and Treatment of Chronic Constipation: Suggestions for a General Practitioner |
| title_full_unstemmed | The Approach to Diagnosis and Treatment of Chronic Constipation: Suggestions for a General Practitioner |
| title_short | The Approach to Diagnosis and Treatment of Chronic Constipation: Suggestions for a General Practitioner |
| title_sort | approach to diagnosis and treatment of chronic constipation suggestions for a general practitioner |
| url | http://dx.doi.org/10.1155/2011/484836 |
| work_keys_str_mv | AT pierrepare theapproachtodiagnosisandtreatmentofchronicconstipationsuggestionsforageneralpractitioner AT pierrepare approachtodiagnosisandtreatmentofchronicconstipationsuggestionsforageneralpractitioner |