ANEMGI-ONLUS  Associazione per la NeUroGastroenterologia e la Motilità Gastrointestinale 
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Constipation Print E-mail

  

Causes of constipation

  • All psychoneurological disorders

Diagnosis of constipation

    In all patients:

  • Exclude structural/biochemical alterations
    Identify pathophysiological role of slow colonic transit and recto-ano-pelvic dysfunction -
  • Large bowel transit -
  • Anorectal manometry
  • Balloon expulsion test
  • In neurologic patients

  • Neurophysiologic investigations of the pelvic floor
  • In specific patients

    • Autonomic test -Defecography
    • Psychiatric assessment

Management of constipation

    Slow colonic transit & normal recto-ano-pelvic function

  • High fiber diet± bulk, osmotic, stimulant laxatives, isosmotic PEG electrolyte solution
  • cisapride
  • If severe & non responding constipation

  • Malone antegrade enema; colectomy
  • Slow colonic transit and no neurological control of the recto-ano-pelvic function

  • High fiber diet ±bulk laxatives & trigger defecatory reflex with physical maneuvers± glycerin, stimulant laxative suppository, enema
  • Cisapride
  • Recto-ano-pelvic dysfunction with only partial or no denervation

  • Toilet training
  • Manometry-controlled biofeedback
  • Isosmotic PEG electrolyte solution
  • Recto-ano-pelvic dysfunction with total denervation

  • Trigger defecatory reflex with physical maneuvers±glycerin, stimulant laxative suppository
  • Electrostimulation of S3-S4 roots
  • Hirschsprung's d *Surgery
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