Abstract
Introduction: Constipation is considered to be one of the commonly encountered clinical conditions around the world. The worldwide prevalence of idiopathic constipation has been approximated to be about fourteen percent. In North America alone, the overall prevalence of chronic constipation was estimated to reach eight percent, disproportionately affecting females more than males and older individuals more than younger individuals. This is likely to be caused by the higher rate of self-reporting of clinical manifestations and the higher rates of injuries to the pelvic floor muscles among females, along with the higher rates of the presence of other comorbidities and in the elderly and the fact that they use many medications. In addition, older individuals are generally more vulnerable to late complications that can potentially follow constipation. Constipation is generally more common in North American countries and European countries, when compared to other Asian countries, possibly because of the presence of cultural diversities, dietary variations, genetic predisposition, and environmental factors. Although constipation is commonly encountered condition, only a third of patients with chronic constipation get a consult from an expert regarding their manifestations. Most patients with constipation tend to manage their clinical manifestations sufficiently with nonpharmacological or lifestyle interventions. On the other hand, other patients with chronic constipation can have clinical manifestations which could be challenging to treat with these simple approaches, and these patients are generally vulnerable to suffer from significant health impairments and decreased quality of life along with psychological distress associated with their GI manifestations. Like other functional GI conditions, chronic constipation could significantly affect productivity and functionality of the patient and lead to declines in social activities of affected patients. In addition, chronic constipation is considered to be associated with high costs on healthcare resources. It is, in fact, approximated that the costs of testing for diagnosing constipation is about $7 billion every year, with additional $500 million to be spent on drugs and other therapies. In the following discussion, we will review the pathophysiology and common causes of constipation, the role of diagnostic tests, and the evidence regarding available medical options for this common condition.. Aim of work: In this review, we will discuss Management of chronic constipation. Methodology: We did a systematic search for Management of chronic constipation using PubMed search engine (http://www.ncbi.nlm.nih.gov/) and Google Scholar search engine (https://scholar.google.com). All relevant studies were retrieved and discussed. We only included full articles. Conclusions: Chronic constipation is a common health problem that has great importance. Clinicians must have great understanding of the common underlying etiologies and pathophysiologies that cause chronic constipation and be able to distinguish between different types of constipation through proper history obtaining, complete physical examination, and the use of available testing modalities. Several therapeutic interventions are generally used for the medical management of constipation, and physicians should modify treatment plans according to the most likely etiology, patients' response, and the presence of concomitant symptoms.
Some experts recommend a step-wise approach for the management of constipation, starting treatment with lifestyle modifications and bulking pharmacological agents, continuing to over-the-counter laxatives, and then to prescription agents in refractory cases. There are sometimes in everyday practice when the use of combination therapy might be needed to improve patients' manifestations and quality of life, but this has not been well-studied or published in the medical literature to provide solid guidelines. Newer agents that have shown promising results in clinical trials and practice are now available, and additional new drugs are in different stages of development.