Managing Slow-Transit Constipation

Abstract

Patients with intractable chronic constipation should be evaluated with physiological tests after structural disorders and extracolonic causes have been excluded. Conservative treatment options should be tried until they are exhausted. If surgery is indicated, STC with IRA is the treatment method of choice, although segmental resection may be a good option for isolated megasigmoid, sigmoidocele, or recurrent sigmoid volvulus. In general, patients with GID should not be offered any surgical options because of their anticipated poor results. Moreover, patients with psychiatric disorders should be actively discouraged from resection, as they tend to have a poorer prognosis. Patients must be counseled that preoperative pain and/or bloating will likely persist, even if surgery normalizes bowel frequency. Patients with associated problems may be served better by having a stoma without resection as both a therapeutic maneuver and a diagnostic trial. Colectomy is not a treatment option for pain and/or abdominal bloating.