Treatment for constipation

After the cause of constipation is characterized, a treatment decision
can be made. Slow transit constipation requires aggressive medical or
surgical treatment; anismus or pelvic floor dysfunction usually responds
to biofeedback management . However, only about
30% of patients with severe constipation are found to have such a
physiologic disorder.

Patients with slow transit constipation are treated with bulk, osmotic,
and stimulant laxatives, including fiber, psyllium, milk of magnesia,
lactulose, polyethylene glycol (colonic lavage solution), and bisacodyl.
If a 2- to 3-month trial of medical therapy fails and patients
continue to have documented slow transit constipation unassociated
with obstructed defecation, colectomy with ileorectostomy is indicated.
The decision to resort to surgery is facilitated in the presence
of megacolon and megarectum. The complications after surgery include
small-bowel obstruction (11%) and fecal soiling, particularly at
night during the first postoperative year.

Patients who have a combined disorder should pursue pelvic floor
retraining (biofeedback and muscle relaxation), psychological counseling,
and dietetic advice first, followed by colectomy and ileorectosomy
if colonic transit studies do not normalize with biofeedback
alone. In patients with pelvic floor dysfunction alone, biofeedback
training has a 70 to 80% success rate, measured by the acquisition of
comfortable stool habits. Attempts to manage pelvic floor dysfunction
with operations (internal anal sphincter or puborectalis muscle division)
have achieved only mediocre success and have been largely
abandoned.

Further readings

What is constipation?
Common causes of constipations
Investigation of severe constipation
Dietary fibers and constipation
Herbal medicine (complementary/alternative medicine) for constipation