1 Recommendation
|
Sr.no. |
Recommendations |
||
|---|---|---|---|
|
1 |
If feasible, discontinue medications that can cause constipation before further testing |
||
| Evidence for Recommendation 1 | |||
|
2 |
A careful digital rectal examination that includes assessment of pelvic floor motion during simulated evacuation is preferable to a cursory examination without these maneuvers and should be performed before referral for anorectal manometry. However, a normal digital rectal examination does not exclude defecatory disorders |
Strong |
|
| Evidence for Recommendation 2 | |||
|
3 |
In the absence of other symptoms and signs, only a complete blood cell count is necessary |
Strong |
Low |
| Evidence for Recommendation 3 | |||
|
4 |
Unless other clinical features warrant otherwise, metabolic tests (glucose, calcium, sensitive thyroid-stimulating hormone) are not recommended for chronic constipation |
Strong |
Mod |
| Evidence for Recommendation 4 | |||
|
5 |
A colonoscopy should not be performed in patients without alarm features (eg, blood in stools, anemia, weight loss) unless age-appropriate colon cancer screening has not been performed |
Strong |
Mod |
| Evidence for Recommendation 5 | |||
|
6 |
Anorectal manometry and a rectal balloon expulsion should be performed in patients who fail to respond to laxatives |
Strong |
Mod |
| Evidence for Recommendation 6 | |||
|
7 |
Defecography should not be performed before anorectal manometry and a rectal balloon expulsion test |
Strong |
Low |
| Evidence for Recommendation 7 | |||
|
8 |
Defecography should be considered when results of anorectal manometry and rectal balloon expulsion are inconclusive for defecatory disorders |
Strong |
Low |
| Evidence for Recommendation 8 | |||
|
9 |
Colonic transit should be evaluated if anorectal test results do not show a defecatory disorder or if symptoms persist despite treatment of a defecatory disorder |
Strong |
Low |
| Evidence for Recommendation 9 | |||
|
10 |
After discontinuing medications that can cause constipation and performing blood and other tests as guided by clinical features, a therapeutic trial (ie, fiber supplementation and/or osmotic or stimulant laxatives) is recommended before anorectal testing |
Strong |
Mod |
| Evidence for Recommendation 10 | |||
|
11 |
NTC and STC can be safely managed with long-term use of laxatives |
Strong |
Mod |
| Evidence for Recommendation 11 | |||
|
12 |
Anorectal tests should be performed in patients who do not respond to these measures |
Strong |
|
| Evidence for Recommendation 12 | |||
|
13 |
Pelvic floor retraining by biofeedback therapy rather than laxatives is recommended for defecatory disorders |
Strong |
High |
| Evidence for Recommendation 13 | |||
|
14 |
When bowel symptoms are refractory to simple laxatives, newer agents should be considered in patients with NTC or STC |
Mod |
|
| Evidence for Recommendation 14 | |||
|
15 |
Anorectal tests and colonic transit should be reevaluated when symptoms persist despite an adequate trial of biofeedback therapy |
Strong |
Low |
| Evidence for Recommendation 15 | |||
|
16 |
A subtotal colectomy rather than continuing therapy with chronic laxatives should be considered for patients with symptomatic STC without a defecatory disorder |
Weak |
Mod |
| Evidence for Recommendation 16 | |||
|
17 |
Colonic intraluminal testing (manometry, barostat) should be considered to document colonic motor dysfunction before colectomy |
Weak |
Mod |
| Evidence for Recommendation 17 | |||
|
18 |
Suppositories or enemas rather than oral laxatives alone should be considered in patients with refractory pelvic floor dysfunction |
Weak |
Low |
SoR: Strength of Recommendation
QoE: Quality of Evidence
Strong: Strong Recommendation
Weak: Weak Recommendation
High: High-Quality Evidence
Mod: Moderate-Quality Evidence
Low: Low-Quality Evidence
NTC: Normal transit constipation
STC: Slow transit constipation