Chronic constipation: diagnostics and surgical treatment issues

Abstract

The article reviews chronic constipation diagnostics and treatment issues. According to the russian and foreign authors data, chronic constipation is a common pathology, which requires an individual approach to the patient and a spacious approach to a diagnostics and treatment problem. Chronic constipation syndrome feature is the delicacy of the problem which makes patients do not seek medical help for a long time, abuse laxatives, trying to eliminate the consequence but not the cause of a latent disease which leads to constipation. The article gives constipation syndrome definition from modern positions and its main classifications, considers the commonest risk factors for chronic constipation in clinical practice. It presents the different pathogenesis theories of the constipation syndrome. Various methods of the intestine anatomical and functional features instrumental diagnostics, as well as anorectal function assessment tests are described. Chronic constipation medicamental treatment results are given. Views on the colostasis resistant forms surgical treatment and different approaches to the selection of surgery type are covered. It is concluded that the chronic constipation problem remains relevant in abdominal surgery due to its wide prevalence, pathophysiological heterogeneity and low efficiency of therapy. At this stage, there are no evidence-based recommendations on the treatment choice for chronic constipation, made on the therapy effectiveness analysis. Rational use of the known diagnostics methods, new directions in diagnostics and therapy, for example, the determination of intestinal microbiota metabolites and designing metabolite-type drugs offers the prospects in solving this problem. The main causes of failure in chronic constipation surgery are inadequate selection of the surgery extent and marked disturbance of the colon evacuation function. Evaluation of the chronic constipation new surgical treatment methods value in the arsenal of modern coloproctology requires the accumulation of more meaningful experience. In addition, surgical interventions methods should be individual and based on understanding of the disease etiopathogenetic aspects. The review is of interest for general practitioners, gastroenterologists, coloproctologists and surgeons.