| Abstract: |
This chapter about constipation is from a comprehensive text that offers chapters about each of the major colonic disorders. Most chapters are coauthored by at least one surgeon and one gastroenterologist to reflect the in-depth collaboration between these fields that is required for managing diseases of the colon. In this chapter, the author discusses constipation, including definition, prevalence and risk factors, history, physical examination, differential diagnosis, medical treatment, physiological investigation, pelvic flood dysfunction, biofeedback, rectocele, cul-de-sac hernias, enterocele and sigmoidocele, intussusception, perineal descent syndrome, combined colonic inertia with outlet obstruction, and normal evaluation. The author cautions that anorectal physiological testing does not reveal the cause in 25 to 50 percent of patients who complain of chronic constipation. Reasons for this include transient symptoms, misperceptions of the normal range of bowel patterns, or psychological causes of the symptoms. Treatment options include conservative therapy, laxatives, suppositories and enemas, prokinetic agents, and, in a small group of patients, surgery. The author concludes that a comprehensive physiologic investigation is crucial to successfully treat these challenging disorders. The chapter includes black-and-white photographs and illustrations and concludes with an extensive list of references. 8 figures. 3 tables. 249 references. |