The modern approach to the diagnosis of chronic constipation

Abstract

A review of literature devoted to the problems of chronic constipation diagnosis is presented. Chronic constipation occurs in all population groups and manifests with persistent or intermittent failure to pass stools. According to the Russian and foreign authors, a significant increase in constipation syndrome prevalence has been seen recently. The variety of etiological factors determines the challenge in diagnostics, and the variety of treating methods - the importance of exact and timely identification of the underlying cause. The definition of constipation syndrome and its classification is presented from the modern point of view, the most widespread risk factors of constipation are reviewed. The different views on the diagnostic algorithms in patients with constipation syndrome are discussed, the need for special questionnaires use to objectively assess patient’s complaints is emphasized. Various methods of instrumental examination of colonic anatomical and functional characteristics and tests assessing the anorectal function are described. Different authors’ opinions on informative value of different diagnostic tests to assess the colonic follow-through are presented. It is concluded that approach to constipated patients is the difficult task, requiring a complex of different clinical and instrumental methods of examination. Thereby an organic etiology of constipation needs to be excluded on a first priority basis. To answer the question if the constipation syndrome is secondary to other disease or is a primary functional disorder is possible only after patient’s careful examination and exclusion of all possible colonic and extracolonic causes. The paper should be interesting for general practitioners, gastroenterologists, coloproctologists and surgeons.