Constipation Management Guidelines for Enhanced Digestive Health

New Guidelines for Constipation Management

The American Society of Colon and Rectal Surgeons (ASCRS) has unveiled new guidelines in the Diseases of the Colon & Rectum journal, published by Wolters Kluwer, on assessing and treating chronic constipation.

Senior author Ian M. Paquette, MD, of the University of Cincinnati, and his colleagues on the ASCRS Clinical Practice Guidelines Committee emphasize that the complex etiology and variable severity of constipation symptoms mandate an individualized approach to evaluation and treatment. After reviewing 134 English-language studies of adults from January 1, 2014, to February 1, 2024, they developed 13 recommendations.

Strong Recommendations

• A directed history and physical examination should be performed.
• The initial management should include dietary modifications and ensuring adequate fluid intake and fiber supplementation.
• Osmotic laxatives are a first-line medical therapy for chronic constipation.
• Stimulant laxatives, such as bisacodyl, may be considered for rescue or second-line therapy.
• Colonic motility and transit should be measured before considering surgical intervention.
• Biofeedback therapy is a first-line treatment for symptomatic pelvic floor dyssynergia.

Additionally, stapled trans-anal rectal resection (STARR) is not recommended due to high complication rates.

Conditional Recommendations

• Objective measures for assessing nature and severity can be useful.
• Patients not improving with dietary changes and fiber therapy should be evaluated for outlet dysfunction.
• Injecting botulinum toxin may help patients suffering from outlet dysfunction related to non-relaxing muscles.
• Surgical repair may be considered for those with significant outlet dysfunction due to rectocele.
• Repairing rectal intussusception may be necessary if non-operative treatments have failed.
• Isolated refractory colonic slow-transit constipation might necessitate a total abdominal colectomy.
• Fecal diversion could be considered in cases resistant to other treatments.

Collaboration across specialties is essential for optimal patient outcomes in constipation management.