The American Society of Colon and Rectal Surgeons

Diseases of the Colon and Rectum: Published October, 2024

Introduction

Chronic constipation is a prevalent condition that significantly impacts patients' quality of life. The American Society of Colon and Rectal Surgeons (ASCRS) has developed clinical practice guidelines to provide evidence-based recommendations for the evaluation and management of this common gastrointestinal issue.

These guidelines aim to assist healthcare providers in diagnosing and treating chronic constipation effectively, ensuring optimal patient outcomes.

TAKE HOME MESSAGE

The ASCRS guidelines emphasize a comprehensive approach to managing chronic constipation. Key recommendations include:

1. Initial Evaluation: A thorough history and physical examination should precede any intervention. Patients should be assessed for red flag symptoms indicating possible underlying conditions.
2. Dietary Modifications (Dietary fiber and water): Increasing dietary fiber intake and adequate hydration are fundamental first-line strategies.

Adding fiber through eating a plant-forward diet and taking a lot of water through the day is not only good for bowel regularity but everything else. Adding a soluble fiber supplement in the form of psyllium or oat bran is the next step.

The other benefit of adding a soluble fiber is that it changes the microbiome to one that is seen in individuals without constipation. The fiber may change the underlying ecosystem rather than just treat a symptom.

3. Medications (Osmotic and stimulant laxatives): Laxatives may be recommended, with a preference for osmotic laxatives due to their efficacy and safety profile.

Polyethylene glycol (PEG) and magnesium salt osmotic laxatives are the next recommendation.

If there is delayed transit time, particularly in older adults, periodic use of a stimulant laxative may prove necessary. This includes bisacodyl, senna, and sodium picosulfate.

Prescription medications like lubiprostone and linaclotide may be considered for refractory cases.

4. Biofeedback Therapy: Patients who do not respond to the above interventions should be evaluated for outlet obstruction. The most common cause is functional and can be diagnosed with a balloon expulsion test (BET). A prolonged or failed test predicts response to biofeedback training. Biofeedback has been found to be successful in 80% of individuals with pelvic floor dysfunction.

4. Surgical Interventions: Surgery should be reserved for cases that are unresponsive to medical therapy, with careful patient selection.

Conclusion

The ASCRS guidelines provide a structured framework for the evaluation and management of chronic constipation. By following these recommendations, healthcare providers can enhance patient care through a tailored approach that considers individual patient needs. Ongoing education and adherence to these guidelines are essential for improving treatment outcomes and quality of life for those suffering from chronic constipation.