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Constipation is a common condition that can be debilitating and difficult to treat. It affects up to 28% of the population in Western countries and results in more than 2.5 million physician visits, 92,000 hospitalizations, and more than $800 million in laxative sales annually in the United States.
A recent review article published in the New England Journal of Medicine (October 2, 2003) focuses on chronic constipation. The authors explain the physiologic processes involved in colonic transit and defecation and summarize patient evaluation and current strategies for clinical management. The multifactorial nature of constipation and its many causes - including low-fiber diet, inadequate hydration, lack of exercise, use of medications, irritable bowel syndrome (IBS), or systemic or neurologic disease - are discussed.
In addition, the authors explain the basis for diagnosis (ie, patient history, physical examination, laboratory tests for systemic disease, therapeutic trials of fiber or laxatives, and specific diagnostic tests such as colonic transit tests or anorectal manometry if fiber/laxative trials are unsuccessful). Also, the article describes the benefits and issues associated with current management options (eg, fiber, laxatives, biofeedback therapy, and prokinetic agents).