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Management of chronic constipation in adults

Arnold Wald, MD
Section Editor
Nicholas J Talley, MD, PhD
Deputy Editor
Shilpa Grover, MD, MPH, AGAF


Constipation is a common complaint that may be due to a variety of causes. Appropriate management requires an evaluation for secondary etiologies, such as systemic disorders and drugs (table 1A-B). Once secondary causes have been eliminated, idiopathic constipation may be associated with normal or slow colonic transit, defecatory dysfunction (pelvic floor dysfunction), or both.

This topic review will discuss the management of idiopathic chronic constipation. The etiology and evaluation of chronic constipation, as well as the management of constipation related to chronic opiates, are discussed elsewhere. (See "Etiology and evaluation of chronic constipation in adults" and "Prevention and management of side effects in patients receiving opioids for chronic pain".)


The approach to a patient with chronic constipation will depend on whether studies indicate normal or slowed colonic transit and whether there is a defecatory dysfunction (algorithm 1). The specific choice of agents and order of their introduction varies with the etiology of the condition.

Management of chronic constipation includes patient education, behavior modification, dietary changes, and laxative therapy. Severe, intractable, slow transit constipation is rare and may be treated with surgery, but with extreme caution; patients should be referred to specialized centers for a full evaluation prior to surgery. Treatment for normal or slow transit constipation is shown in an algorithm (algorithm 2).

Management of defecatory dysfunction involves suppositories, biofeedback, or botulinum toxin injections into the puborectalis muscle (algorithm 3).

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Literature review current through: Nov 2017. | This topic last updated: Feb 01, 2017.
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