New Guidelines for Effective Management of Constipation in Digestive Health

New Guidelines Unveiled

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

Strong Recommendations

• A directed history and physical examination should be performed.
• Initial management includes dietary modifications and a focus on adequate fluid intake and fiber supplementation.
• Osmotic laxatives are recommended as the first-line therapy for chronic constipation.
• Consider stimulant laxatives like bisacodyl for rescue therapy or as second-line options.
• Colonic motility and transit measurements are crucial before surgical interventions.
• Biofeedback therapy is recommended for patients with symptomatic pelvic floor dyssynergia.
• Stapled trans-anal rectal resection (STARR) should be avoided due to high complication rates.

Conditional Recommendations

• Objective measures to evaluate nature and severity of constipation can be beneficial.
• Patients not improving with dietary changes, fiber therapy, and osmotic laxatives should be evaluated for outlet dysfunction.
• Injections of botulinum toxin may be appropriate for outlet dysfunction related to non-relaxing puborectalis muscle.
• Consider surgical repair for patients with rectocele after addressing functional issues.
• Repair of rectal intussusception may be an option for severe obstructed defecation cases.
• Isolated refractory colonic slow-transit constipation may benefit from total abdominal colectomy with ileorectal anastomosis.
• Fecal diversion could be considered for patients with intractable constipation that resists other treatments.

Collaborative approaches are emphasized, as various specialties manage constipation, highlighting the importance of teamwork for optimal patient outcomes.