Management of chronic constipation in adults.
Level 5 - mechanism / opinion, no new human data
Narrative clinical review without systematic methodology or primary human trial data.
PubMed 28588875 · doi:10.1177/2050640616663439
What was done
Narrative review outlining the diagnostic approach and stepwise clinical management algorithm for chronic constipation in adult primary and secondary care settings.
What was found
The abstract reports that chronic constipation has an estimated prevalence of up to 24%. No further quantitative outcome data or comparative effect sizes are provided. The authors outline a stepped care pathway: initial lifestyle modifications (dietary fiber, fluid intake, exercise) followed by osmotic or stimulant laxatives; second-line prokinetics and secretagogues; physiological testing (anorectal physiology, colorectal transit time, evacuation proctography) for non-responders or suspected structural defects; biofeedback for dyssynergic defecation; rectal therapies or transanal irrigation for evacuation disorders; and surgery strictly for severe, treatment-refractory disease.
Why it matters
It provides a structured, stepwise decision framework for clinicians to systematically escalate treatment from simple primary care interventions to advanced physiological testing and specialized therapies.
Limits
As a narrative review, it lacks a systematic literature search, formal risk-of-bias evaluation, and quantitative meta-analytic comparisons. Specific drug dosages, absolute response rates, and comparative efficacy metrics are not reported in the abstract.
Cited by
- context About one in three people with treatment-resistant constipation have pelvic floor dysfunction as the primary cause.