title: Primary Care Management of Chronic Constipation in Asia: The ANMA Chronic Constipation Tool.
abstract: Chronic constipation (CC) may impact on quality of life. There is substantial patient dissatisfaction; possible reasons are failure to recognize underlying constipation, inappropriate dietary advice and inadequate treatment. The aim of these practical guidelines intended for primary care physicians, and which are based on Asian perspectives, is to provide an approach to CC that is relevant to the existing health-care infrastructure. Physicians should not rely on infrequent bowel movements to diagnose CC as many patients have one or more bowel movement a day. More commonly, patients present with hard stool, straining, incomplete feeling, bloating and other dyspeptic symptoms. Physicians should consider CC in these situations and when patients are found to use laxative containing supplements. In the absence of alarm features physicians may start with a 2-4 week therapeutic trial of available pharmacological agents including osmotic, stimulant and enterokinetic agents. Where safe to do so, physicians should consider regular (as opposed to on demand dosing), combination treatment and continuous treatment for at least 4 weeks. If patients do not achieve satisfactory response, they should be referred to tertiary centers for physiological evaluation of colonic transit and pelvic floor function. Surgical referral is a last resort, which should be considered only after a thorough physiological and psychological evaluation.
authors.affiliation: Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
authors.forename: Kok-Ann
authors.initials: KA
authors.lastname: Gwee
authors.forename: Uday C
authors.initials: UC
authors.lastname: Ghoshal
authors.forename: Sutep
authors.initials: S
authors.lastname: Gonlachanvit
authors.forename: Andrew Seng Boon
authors.initials: AS
authors.lastname: Chua
authors.forename: Seung-Jae
authors.initials: SJ
authors.lastname: Myung
authors.forename: Shaman
authors.initials: S
authors.lastname: Rajindrajith
authors.forename: Tanisa
authors.initials: T
authors.lastname: Patcharatrakul
authors.forename: Myung-Gyu
authors.initials: MG
authors.lastname: Choi
authors.forename: Justin C Y
authors.initials: JC
authors.lastname: Wu
authors.forename: Min-Hu
authors.initials: MH
authors.lastname: Chen
authors.forename: Xiao-Rong
authors.initials: XR
authors.lastname: Gong
authors.forename: Ching-Liang
authors.initials: CL
authors.lastname: Lu
authors.forename: Chien-Lin
authors.initials: CL
authors.lastname: Chen
authors.forename: Nitesh
authors.initials: N
authors.lastname: Pratap
authors.forename: Philip
authors.initials: P
authors.lastname: Abraham
authors.forename: Xiao-Hua
authors.initials: XH
authors.lastname: Hou
authors.forename: Meiyun
authors.initials: M
authors.lastname: Ke
authors.forename: Jane D
authors.initials: JD
authors.lastname: Ricaforte-Campos
authors.forename: Ari Fahrial
authors.initials: AF
authors.lastname: Syam
authors.forename: Murdani
authors.initials: M
authors.lastname: Abdullah
keywords: Asia; Constipation; Management; Physicians, primary care