ABSTRACT
Constipation is a major medical problem in the United States, affecting 2% to 28%
of the population. Individual patients may have different conceptions of what constipation
is, and the findings overlap with those in other functional gastrointestinal disorders.
In 1999, an international panel of experts laid out specific criteria for the diagnosis
of constipation known as the Rome II criteria. When patients present with complaints
of constipation, a complete history and physical examination can elicit the cause
of constipation. It is imperative to rule out a malignancy or other organic causes
of the patient's symptoms prior to making the diagnosis of functional constipation.
Many patients' symptoms can be relieved with lifestyle and dietary modification, both
of which should be implemented before other potentially unnecessary tests are performed.
Functional constipation is divided into two subtypes: slow transit constipation and
obstructive defecation. Because many different terms are used interchangeably to describe
these subtypes of constipation, physicians need to be comfortable with the language.
Slow transit constipation is due to abnormal colonic motility. The diagnosis is made
with the use of a colonic transit study. We continue to use a single-capsule technique
as first described in the literature, but modifications of the capsule technique as
well as scintigraphic techniques are validated and can be substituted in place of
the capsule.
Obstructive defecation is a much more complex problem, with etiologies ranging from
rare diseases such as Hirschsprung's to physiologic abnormalities such as paradoxical
puborectalis contraction. To fully evaluate the patient with obstructive defecation,
anorectal manometry, defecography, and electromyography should be utilized. The different
techniques available for each test are fully covered in this article.
When evaluating each patient with constipation, it is important to keep in mind that
the disease may be specific to one subtype or a combination of both subtypes. Because
it is difficult to differentiate the subtypes from the patient's history, we feel
it is imperative to evaluate patients fully for both slow transit and obstructive
defecation prior to any surgical intervention. Furthermore, we have described many
tests that need to be applied to one's population of patients on the basis of the
capabilities and expertise the institution offers.
KEYWORDS
Constipation - physiologic testing - manometry - defecography - colonic transit study
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Eric G WeissM.D.
Department of Colorectal Surgery, Cleveland Clinic Florida
2950 Cleveland Clinic Blvd., Weston, FL 33326
eMail: weisse@ccf.org
