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Chronic constipation
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DOI：10.1038/nrdp.2017.95.png)
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Abstract
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Chronic constipation is a prevalent condition that severely impacts the quality of life of those affected. Several types of primary chronic constipation, which show substantial overlap, have been described, including normal-transit constipation, rectal evacuation disorders and slow-transit constipation. Diagnosis of primary chronic constipation involves a multistep process initiated by the exclusion of 'alarm' features (for example, unintentional weight loss or rectal bleeding) that might indicate organic diseases (such as polyps or tumours) and a therapeutic trial with first-line treatments such as dietary changes, lifestyle modifications and over-the-counter laxatives. If symptoms do not improve, investigations to diagnose rectal evacuation disorders and slow-transit constipation are performed, such as digital rectal examination, anorectal structure and function testing (including the balloon expulsion test, anorectal manometry or defecography) or colonic transit tests (such as the radiopaque marker test, wireless motility capsule test, scintigraphy or colonic manometry). The mainstays of treatment are diet and lifestyle interventions, pharmacological therapy and, rarely, surgery. This Primer provides an introduction to the epidemiology, pathophysiological mechanisms, diagnosis, management and quality of life associated with the commonly encountered clinical problem of chronic constipation in adults unrelated to opioid abuse.
Keywords:
IRRITABLE-BOWEL-SYNDROME
QUALITY-OF-LIFE
SLOW-TRANSIT CONSTIPATION
SACRAL NERVE-STIMULATION
PLACEBO-CONTROLLED TRIAL
CHRONIC IDIOPATHIC CONSTIPATION
PROPAGATING PRESSURE WAVES
FUNCTIONAL GASTROINTESTINAL DISORDERS
RESOLUTION ANORECTAL MANOMETRY
CLINICAL-PRACTICE GUIDELINE
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