Constipation is one of the most common chronic diseases of the digestive tract, affecting between 2 and 35% of the general population. Constipation is not a disease, but rather a symptom that can be the result of numerous diseases. Constipation can therefore be classified as primary or secondary, depending on whether the cause of the intestinal dysfunction is suspected or not. Primary constipation has its origin in the neuromuscular intestinal system itself; secondary constipation has a local or systemic cause.

Primary constipation:

  • Transport disorder in the large intestine (insufficient contraction waves)
  • Malfunction of the pelvic floor (= defecation disorder)
  • Irritable Bowel Syndrome

Secondary constipation:

  • Gastrintestinal causes (colon cancer, diverticular disease, anal cancer, anal stenosis)
  • Extra-gastrointestinal causes (hypothyroidism, multiple sclerosis, Parkinson’s disease, spinal nerve lesions, medication, scleroderma, etc.)

A thorough clinical history can usually distinguish whether it is primary or secondary constipation. Further examinations are based on this and finally point to a specific treatment.

In the case of primary chronic constipation, a colon transit with markers (X-ray examination) and a dynamic magnetic resonance examination are mandatory. Whether additional examinations such as anorectal physiological tests are required depends on the results of the imaging.

Medical therapies, such as oral medications, are most relevant for transit disorders, while rectal laxatives and behavioral therapy are most effective for defecation disorder.

Surgical procedures for constipation with slow colon passage include:

  • Sacral nerve stimulation (SNS)
  • Segment and total colon removal
  • Ileostomy (artificial anus).

Surgical treatment of defecation disorders is aimed at correcting anatomical abnormalities with the intention that the correction will improve function. Conditions for which surgery should be considered almost exclusively include rectocele, intussusception, and enterocele.

  • Rectal plication (Sullivan-Khubchandani technique)
  • Transanal rectal resection with clamps (STARR or Transtar)
  • Transperineal levator plasty
  • Laparoscopic colorectosacropexy