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Gulhane Med J. 2010; 52(1): 061-068


Etiology, diagnostic procedures and treatment modalities in chronic constipation

Sezai Demirbaž.

Abstract
Symptoms in chronic, and even acute constipation rarely help in establishing the diagnosis of constipation. Most of the diagnostic tests used, however, are not useful. The aim of this article is demonstrate the usefulness and indications of the tests used in the diagnosis of constipation with various etiologies. In this way the scientist, himself/herself, will be able to make the restriction about the use of unnecessary tests. Meta-analyses, controlled and cohort studies published in English and Turkish in web-based media between 1978 and 2006 were reviewed, and those with a category of A-B-C as evidence based medicine were included. Routine use of guiac positive stool test or upright abdominal x-ray has not been reported in any of the studies reviewed. However, barium enema colon graphy and endoscopy are studies used in the control of the patient and in the evaluation of the patients without a diagnosis. There is no diagnostic test that can be helpful in the diagnosis accepted as gold standard. Guiac positive stool test, endoscopy and radiographic tests are not specific in the diagnosis of constipated patients without any characteristics, whereas anorectal manometry and balloon expulsion test guide a surgeon about the decision of treatment. Most patients should be tried to be treated with medical treatment at the first step treatment. Surgery should be performed for selected patients, and these patients should be evaluated with further tests to determine the type of surgical method.

Key words: Anal function, anal manometer, chronic onstipation, pelvic floor disorders, rectal ulser, diagnosis and treatment



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