The Roles of Anorectal Physiologic Tests and Treatment of Chronic Constipation

Abstract

Patients with chronic constipation should be evaluated with physiological tests (defecography and cinedefecography, anal manometry, anal electromyography, and colon transit time) after structural disorders and extracolonic causes have been excluded. In the case of colonic inertia, at first, conservative treatment is necessary. If surgery is indicated, a subtotal colectomy with ileorectal anastomosis is the treatment of choice. Biofeedback is the best option for animus. For patients failing biofeedback, botulinum toxin injection of the puborectalis or sacral nerve stimulation may be indicated. Biofeedback treatment is also considered to be an option for moderate-degree rectoceles, rectal intussusception, and perineal descending syndrome. For the treatment of a severe rectocele, a surgical approach, including transrectal, transvaginal, and transperineal repair or stapled transanal rectal resection (STARR) should be considered. However, the long-term effects of a new technique including botulinum toxin injection, sacral nerve stimulation, and STARR remain to be established.