Constipation. Mechanisms and management of a common clinical problem

Constipation is a common symptom. It may be idiopathic or due to an underlying disorder. Patients should be evaluated for structural lesions, metabolic abnormalities, neuromuscular disease, anorectal disease, and ingestion of a drug known to cause constipation. Idiopathic constipation is a diagnosis of exclusion; its pathophysiology is as yet not understood. Management of chronic constipation includes discontinuation of laxative therapy, counselling to achieve healthy bowel habits, and if necessary, drug therapy with agents least likely to have toxic effects. Complications more commonly result from laxative use than from constipation. Examples, 'cathartic colon', and melanosis coli. Fecal impaction may cause intestinal obstruction, or rarely, intestinal perforation.