Evaluation and treatment of colonic symptoms.
Important considerations for constipation include: 1. Initial evaluation should evaluate for fecal incontinence, fecal impaction, medication side effects, concerning symptoms, underlying medical or metabolic issues and irritable bowel syndrome. 2. History and examination should be used to determine if a defecatory disorder is most likely. a. If defecatory disorder is likely, testing with balloon expulsion or anal manometry can be considered and, if confirmed, treatment with biofeedback (if testing not available, it is reasonable to trial fiber and laxatives because many patients have a mixed disorder). b. If it is unlikely, proceed with trial of fiber and/or osmotic laxatives. 3. If continued symptoms, consider trial of newer agent (lubiprostone or linaclotide). 4. If ineffective, consider testing for colon transit time and referral to gastroenterology.
Department of Medicine, University of Vermont College of Medicine, 1234 Spear Street, 111 Colchester Avenue, South Burlington, VT 05403, USA. Electronic address: mark.pasanen@yahoo.com.
Mark E
ME
Pasanen
D003108:Colonic Diseases / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D003248:Constipation / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D003937:Diagnosis, Differential; D003967:Diarrhea / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D006801:Humans
Antidiarrheals; Constipation; Diarrhea; Irritable bowel syndrome; Laxatives