title: [Guidelines for diagnosis and treatment of constipation in Mexico. C) Medical and surgical treatment].
abstract: BACKGROUND
  There are multiple therapeutic options for the management of constipation, from lifestyle modifications to the use of laxatives and in extreme cases surgery.
  
  
  OBJECTIVE
  To establish the clinical guidelines for diagnosis and treatment of chronic constipation in Mexico we conducted a review of the literature regarding medical and surgical treatments for chronic constipation and have made recommendations based on evidence.
  
  
  RESULTS
  Low water consumption, physical inactivity and low intake of fiber are conditions associated with chronic constipation, but the evidence to prove these associations is scarce. Bolus forming agents are useful in the management of constipation with normal colonic transit and defecation without dissynergia. Evidence supports the use of lactulose (IB) and polyethylene glycol (IA) as the most safe and effective agents in the long term in adults. The use of stimulant laxatives (docusate, picosulfate, senna) is recommended only for short periods. Tegaserod is an agonist of 5-HT4 receptors and there are many clinical trials supporting its effectiveness in the management of functional constipation (IA). However "their cardiovascular safety has been questioned recently. Biofeedback therapy is the gold standard in the management of constipation associated with pelvic floor dyssynergia. Surgical treatment is reserved for extreme cases of colonic inertia.
  
  
  CONCLUSIONS
  The treatment of constipation should be based on the underlying pathophysiological mechanisms and the selection of drugs must be made according to the scientific evidence.
authors: Laboratorio de Fisiología Digestiva, Instituto de Investigaciones Medico Biológicas, Universidad Veracruzana, México. jose.remes.troche@gmail.com
authors: José María
authors: JM
authors: Remes Troche
authors: Octavio
authors: O
authors: Gómez Escudero
authors: María Eugenia
authors: ME
authors: Icaza Chávez
authors: Alejandra
authors: A
authors: Noble Lugo
authors: Aurelio
authors: A
authors: López Colombo
authors: María Victoria
authors: MV
authors: Bielsa
authors: Luis
authors: L
authors: Charúa Guindic
mesh_terms: D002908:Chronic Disease; D003248:Constipation / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D004599:Electric Stimulation Therapy; D019317:Evidence-Based Medicine; D025461:Feedback, Physiological; D006801:Humans; D054368:Laxatives / Q000627:therapeutic use; D008019:Life Style; D008800:Mexico
chemical_list: D054368:Laxatives