Constipation is a very common problem in the United States. The initial management of constipation includes increasing daily water consumption to two to three and a half liters and increasing fiber to 25-35 grams per day. Increase in exercise and activity is also recommended. The addition of a mild osmotic laxative, such as Milk of Magnesia, Miralax or Lactulose may be beneficial. These types of laxatives cannot cause habituation nor have any long term damaging effects. One may increase or decrease the dosage according to consistency of the stool. Lobiprostone (Amitiza) may also be effective.
Patients that fail primary management would proceed to a full evaluation which would probably entail a colonoscopy and evaluation in the rectal physiology lab. This also may include a radio opaque marker study (sitzmark) of the colon to determine colonic transit time. Abdominal x-ray would be obtained daily for seven days after ingesting the markers. The passage of the markers along with the distribution pattern would be diagnostic to the cause of constipation. Defecography would also be important in determining if the problem was rectal or pelvic in nature.
There is a rare form of constipation (colonic inertia) in which patients would benefit by surgical removal of the colon and attachment of the small intestine to the rectum. Excellent results are usually obtained with patients having two to four bowel movements per day and no incontinence or pain. This procedure is frequently done laparoscopically.
If constipation is secondary to a pelvic outlet problem, we have many surgical and non surgical ways to resolve or improve the problem.
For more information please visit:
The American Board of Colon and Rectal Surgeons