Chronic constipation: everything you need to know
Chronic constipation has historically been considered a common disorder, yet one that is frequently underestimated in its clinical complexity and pathophysiology. For years, its management was limited to symptomatic relief through empirical interventions, often disconnected from the underlying pathophysiological mechanisms. This context, still prevalent in many clinical settings, has contributed to the persistence of suboptimal […]
Definition, epidemiology and subtypes of chronic constipation
Introduction Disorders of gut-brain interaction (DGBI) have a high prevalence in the general population, as they affect any group regardless of sex, race, age, or socioeconomic status. They entail a significant impact on the quality of life of those who suffer from them and have a negative economic impact on the health care system. According […]
Anatomy and physiology of the colon: foundations for understanding constipation
Introduction Constipation is a highly prevalent gastrointestinal disorder affecting populations of all ages, with greater frequency among women and older adults.1,2 It is associated with a negative impact on quality of life, work productivity, and psychological well-being, in addition to generating a considerable burden on healthcare systems.3 Despite its frequency, constipation represents a clinically heterogeneous […]
Pathophysiology of functional constipation
Neurophysiological mechanisms of defecation Primary chronic constipation is commonly associated with abnormalities in intestinal movements or dysfunction of coordinated pelvic floor muscle contraction during defecation. The motor activity that supports propulsive motility throughout most of the gastrointestinal tract is peristalsis, which involves coordinated contraction and relaxation of the intestinal muscle layer, resulting in a pressure […]
Usefulness of diagnostic tests in constipation
Introduction The diagnostic approach to constipation must be selective, targeted, and stepwise, avoiding both the underutilization and the indiscriminate use of tests. Diagnostic investigations are not intended to “confirm” constipation, but rather to identify its underlying mechanism, differentiate pathophysiological subtypes, and guide specific therapeutic decisions. In patients with persistent constipation despite initial measures, functional evaluation […]
New treatments for chronic constipation: what is the evidence?
Introduction Chronic constipation (CC) is defined by the presence of two or more of the following symptoms: excessive straining, fewer than three bowel movements per week, passage of hard stools, sensation of incomplete evacuation, use of digital maneuvers to assist defecation, and sensation of anorectal blockage during the defecatory act. These symptoms must have been […]
Non-pharmacological therapy: biofeedback and more
Introduction The global prevalence of functional chronic constipation (CC), according to the Rome IV criteria, is 11.7%, and refractoriness to pharmacological treatment is reported in approximately 36% of cases. This lack of response could be attributed primarily to the presence of defecation disorders (DD), whose prevalence in CC is estimated at around 40%, and to […]
Dietary and lifestyle recommendations for constipation
Introduction Constipation is a common gastrointestinal disorder in outpatient care, with an estimated prevalence of 10% to 15% in adults and a greater impact in women and adults aged 65 years and older.1 Its clinical and quality-of-life impact is considerable, which justifies the implementation of effective and sustainable therapeutic strategies. Non-pharmacological interventions, particularly dietary and […]
Complications of chronic constipation
Introduction Chronic constipation in Mexico has a prevalence of 14% to 22%. The pathophysiological mechanisms of constipation may occur in isolation or in combination and include slow intestinal transit, evacuation disorders (defecatory dyssynergia), and alterations in rectal sensitivity. When this condition is not adequately treated, it may give rise to various complications (Table 1) that […]
Refractory constipation
Introduction Functional constipation (FC) or chronic constipation (CC) is a common gastrointestinal disorder characterized primarily by symptoms including infrequent bowel movements, straining during defecation, hard stools, abnormally prolonged defecation time, the need for digital maneuvers, and a sensation of incomplete evacuation.1 CC has a high worldwide prevalence, ranging from 9% to 20% depending on the […]