Chronic Functional Constipation and Dyssynergic Defecation

Chronic functional constipation is defined on the basis of symptoms alone, but dyssynergic defecation requires symptoms and physiological tests for confirmation (Rome III criteria). Exclusion of organic diseases is the first step in the evaluation of constipation. Key symptoms of constipation include straining, lumpy or hard stools, feelings of incomplete evacuation, a sense of anorectal blockage, digital maneuvers to facilitate defecation, and fewer than three bowel movements per week. Useful investigations may include colonic transit studies, anorectal manometry, colonic manometry, dynamic MRI, and electrophysiological tests. Management includes general measures, laxatives, prokinetics, and secretagogues Biofeedback therapy is effective in patients with dyssynergic defecation. Selected refractory cases of slow-transit constipation with neuropathy may respond to surgery or sacral nerve stimulation.