title: Consensus statement AIGO/SICCR diagnosis and treatment of chronic constipation and obstructed defecation (part II: treatment).
abstract: The second part of the Consensus Statement of the Italian Association of Hospital Gastroenterologists and Italian Society of Colo-Rectal Surgery reports on the treatment of chronic constipation and obstructed defecation. There is no evidence that increasing fluid intake and physical activity can relieve the symptoms of chronic constipation. Patients with normal-transit constipation should increase their fibre intake through their diet or with commercial fibre. Osmotic laxatives may be effective in patients who do not respond to fibre supplements. Stimulant laxatives should be reserved for patients who do not respond to osmotic laxatives. Controlled trials have shown that serotoninergic enterokinetic agents, such as prucalopride, and prosecretory agents, such as lubiprostone, are effective in the treatment of patients with chronic constipation. Surgery is sometimes necessary. Total colectomy with ileorectostomy may be considered in patients with slow-transit constipation and inertia coli who are resistant to medical therapy and who do not have defecatory disorders, generalised motility disorders or psychological disorders. Randomised controlled trials have established the efficacy of rehabilitative treatment in dys-synergic defecation. Many surgical procedures may be used to treat obstructed defecation in patients with acquired anatomical defects, but none is considered to be the gold standard. Surgery should be reserved for selected patients with an impaired quality of life. Obstructed defecation is often associated with pelvic organ prolapse. Surgery with the placement of prostheses is replacing fascial surgery in the treatment of pelvic organ prolapse, but the efficacy and safety of such procedures have not yet been established.
authors.affiliation: Gastroenterology and Endoscopy Unit, Department of Gastroenterology, AORN "A. Cardarelli", 80131 Naples, Italy. 3392982380@fastwebnet.it
authors.forename: Antonio
authors.initials: A
authors.lastname: Bove
authors.forename: Massimo
authors.initials: M
authors.lastname: Bellini
authors.forename: Edda
authors.initials: E
authors.lastname: Battaglia
authors.forename: Renato
authors.initials: R
authors.lastname: Bocchini
authors.forename: Dario
authors.initials: D
authors.lastname: Gambaccini
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Bove
authors.forename: Filippo
authors.initials: F
authors.lastname: Pucciani
authors.forename: Donato Francesco
authors.initials: DF
authors.lastname: Altomare
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Dodi
authors.forename: Guido
authors.initials: G
authors.lastname: Sciaudone
authors.forename: Ezio
authors.initials: E
authors.lastname: Falletto
authors.forename: Vittorio
authors.initials: V
authors.lastname: Piloni
mesh_terms: D002908:Chronic Disease; D020117:Cisapride / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D003082:Colectomy; D003248:Constipation / Q000175:diagnosis* / Q000628:therapy*; D004043:Dietary Fiber / Q000008:administration & dosage*; D005772:Gastrointestinal Transit; D006801:Humans; D007415:Intestinal Obstruction / Q000175:diagnosis* / Q000628:therapy*; D054368:Laxatives / Q000627:therapeutic use*; D019936:Probiotics / Q000627:therapeutic use
chemical_list: D004043:Dietary Fiber; D054368:Laxatives; D020117:Cisapride