Diagnosis of Chronic Constipation.

Seon-Young Park
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Abstract

Patients with chronic constipation (CC) usually complain of mild to severe symptoms, including hard or lumpy stools, straining, a sense of incomplete evacuation after a bowel movement, a feeling of anorectal blockage, the need for digital maneuver to assist defecation, or reduced stool frequency. In clinical practice, healthcare providers need to check for 'alarm features' indicative of a colonic malignancy, such as bloody stools, anemia, unexplained weight loss, or new-onset symptoms after 50 years of age. In the Seoul Consensus on the diagnosis and treatment of chronic constipation, the Bristol stool form scale, colonoscopy, and digital rectal examination are useful for objectively evaluating the symptoms and making a differential diagnosis of the secondary cause of constipation. If patients with CC improve to lifestyle modification or first-line therapies, the effort to determine the subtypes of CC is usually not considered. On the other hand, if conventional therapeutic strategies fail, diagnostic testing needs to be considered to distinguish between the different subtypes of functional constipation (normal-transit constipation, slow transit constipation, or defecatory disorder) because these subtypes of constipation have different therapeutic implications and a correct diagnosis is critical. In the Seoul consensus, physiological testing is recommended for patients with functional constipation who have failed to respond to treatment with available laxatives (for a minimum of 12 weeks and recommended a therapeutic regimen) or who are strongly suspected of having a defecatory disorder. The Seoul consensus contains statements of physiological testing, including balloon expulsion test, anorectal manometry, defecography, and colon transit time.

诊断慢性便秘。
慢性便秘(CC)患者通常主诉轻度至重度症状,包括粪便坚硬或结块、排便费力、排便后排空不完全感、肛门直肠堵塞感、需要数字手法协助排便或排便次数减少。在临床实践中,医护人员需要检查结肠恶性肿瘤的 "报警特征",如血便、贫血、不明原因的体重减轻或 50 岁以后新出现的症状。在慢性便秘的诊断和治疗首尔共识中,布里斯托粪便形态量表、结肠镜检查和数字直肠检查有助于客观评估症状,并对便秘的继发原因进行鉴别诊断。如果慢性便秘患者在改变生活方式或接受一线治疗后病情有所好转,通常不需要考虑确定慢性便秘的亚型。另一方面,如果常规治疗策略失败,则需要考虑进行诊断测试,以区分功能性便秘的不同亚型(正常排便型便秘、缓慢排便型便秘或排便障碍),因为这些亚型的便秘具有不同的治疗意义,正确诊断至关重要。在首尔共识中,建议对使用现有泻药(至少 12 周,并推荐一种治疗方案)治疗无效或强烈怀疑患有排便障碍的功能性便秘患者进行生理检测。首尔共识包含生理检查声明,包括气球排出试验、肛门直肠测压、排便造影和结肠转运时间。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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