With a worldwide prevalence of 15%, chronic constipation is one of the most frequent gastrointestinal diagnoses made in ambulatory medicine clinics and is a common source cause for referrals to gastroenterologists and colorectal surgeons in the United States. Symptoms vary among patients; straining, incomplete evacuation, and a sense of anorectal blockage are just as important as decreased stool frequency. Chronic constipation is either a primary disorder (such as normal transit, slow transit, or defecatory disorders) or a secondary one (due to medications or in rare cases anatomic alterations). Colonic sensorimotor disturbances and pelvic floor dysfunction (such as defecatory disorders) are the most widely recognized pathogenic mechanisms. Guided by efficacy and cost, management of constipation should begin with dietary fiber supplementation and stimulant and/or osmotic laxatives, as appropriate, followed, if necessary, by intestinal secretagogues and/or prokinetic agents. Peripherally acting μ-opiate antagonists are another option for opioid-induced constipation. Anorectal tests to evaluate for defecatory disorders should be performed in patients who do not respond to over-the-counter agents. Colonic transit, followed if necessary with assessment of colonic motility with manometry and/or a barostat, can identify colonic dysmotility. Defecatory disorders often respond to biofeedback therapy. For specific patients, slow-transit constipation may necessitate a colectomy. No studies have compared inexpensive laxatives with newer drugs with different mechanisms. We review the mechanisms, evaluation, and management of chronic constipation. We discuss the importance of meticulous analyses of patients' histories and physical examination, advantages and disadvantages of diagnostic testing, guidance for individualized treatment, and management of medically refractory patients.

中文翻译：

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慢性便秘的机制、评估和治疗。

慢性便秘的全球患病率为 15%，是门诊医疗诊所最常见的胃肠道诊断之一，也是美国胃肠病学家和结直肠外科医生转诊的常见原因。患者的症状各不相同；用力、排空不完全和肛门直肠阻塞感与排便次数减少同样重要。慢性便秘要么是一种原发性疾病（如正常传输障碍、慢传输障碍或排便障碍），要么是继发性疾病（由于药物或在极少数情况下由于解剖结构改变）。结肠感觉运动障碍和盆底功能障碍（例如排便障碍）是最广泛认可的致病机制。在功效和成本的指导下，便秘的治疗应从补充膳食纤维和适当的兴奋剂和/或渗透性泻药开始，如有必要，随后使用肠道促分泌剂和/或促动力剂。外周作用的 μ-阿片拮抗剂是治疗阿片类药物引起的便秘的另一种选择。对非处方药没有反应的患者应进行肛门直肠检查以评估排便障碍。结肠转运，如有必要，随后用测压法和/或恒压器评估结肠运动，可以识别结肠运动障碍。排便障碍通常对生物反馈疗法有反应。对于特定患者，慢传输型便秘可能需要结肠切除术。没有研究将廉价的泻药与具有不同机制的新型药物进行比较。我们回顾了慢性便秘的机制、评估和治疗。我们讨论了仔细分析患者病史和体格检查的重要性、诊断检测的优缺点、个体化治疗指导以及难治性患者的管理。