Causes of constipation

• All psychoneurological disorders

Diagnosis of constipation

In all patients:

• Exclude structural/biochemical alterations
  Identify pathophysiological role of slow colonic transit and recto-ano-pelvic dysfunction -
• Large bowel transit -
• Anorectal manometry
• Balloon expulsion test

In neurologic patients

• Neurophysiologic investigations of the pelvic floor

In specific patients

• Autonomic test -Defecography
• Psychiatric assessment

Management of constipation

Slow colonic transit & normal recto-ano-pelvic function

• High fiber diet± bulk, osmotic, stimulant laxatives, isosmotic PEG electrolyte solution
• cisapride

If severe & non responding constipation

• Malone antegrade enema; colectomy

Slow colonic transit and no neurological control of the recto-ano-pelvic function

• High fiber diet ±bulk laxatives & trigger defecatory reflex with physical maneuvers± glycerin, stimulant laxative suppository, enema
• Cisapride

Recto-ano-pelvic dysfunction with only partial or no denervation

• Toilet training
• Manometry-controlled biofeedback
• Isosmotic PEG electrolyte solution

Recto-ano-pelvic dysfunction with total denervation

• Trigger defecatory reflex with physical maneuvers±glycerin, stimulant laxative suppository
• Electrostimulation of S3-S4 roots
• Hirschsprung's d *Surgery