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When fiber is not enough: current thinking on constipation management.
Ostomy Wound Manage. 2002 Dec; 48(12):30-41.OW

Abstract

Constipation is a common disorder and many patients fail to respond to the simple constipation remedies of increased fiber and fluid intake. When secondary to other conditions, medications, or disease processes, the focus of constipation management is correction of causative factors. However, primary constipation - ie, constipation with no identifiable causative factor - is very common. Patients generally present with one of three patterns: constipation-predominant irritable bowel syndrome, slow transit constipation, or pelvic floor dysfunction resulting in dyssynergic defecation. Baseline evaluation for patients with chronic constipation includes a careful history, focused physical examination, and limited laboratory studies. Patients with dyssynergic defecation usually respond best to biofeedback therapy and pelvic muscle re-education. Constipation-predominant irritable bowel syndrome is best managed with dietary monitoring and modifications, fiber therapy, and education regarding self-monitoring and self-care. Patients with slow transit constipation may benefit from fiber therapy and increased activity, but most also will require laxative therapy. Current guidelines for prescribing laxatives suggest bulk agents as first line and osmotic agents as second line therapy. Stimulant laxatives should generally be reserved for PRN use. Current understanding about the etiology, pathology, and classification of different types of constipation are summarized and a stepwise approach to evaluation and management is presented.

Authors+Show Affiliations

Emory University Wound Ostomy Continence Nursing Education Center, Atlanta, GA 30322, USA. ddoughty@emory.edu

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

12490751

Citation

Doughty, Dorothy B.. "When Fiber Is Not Enough: Current Thinking On Constipation Management." Ostomy/wound Management, vol. 48, no. 12, 2002, pp. 30-41.
Doughty DB. When fiber is not enough: current thinking on constipation management. Ostomy Wound Manage. 2002;48(12):30-41.
Doughty, D. B. (2002). When fiber is not enough: current thinking on constipation management. Ostomy/wound Management, 48(12), 30-41.
Doughty DB. When Fiber Is Not Enough: Current Thinking On Constipation Management. Ostomy Wound Manage. 2002;48(12):30-41. PubMed PMID: 12490751.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - When fiber is not enough: current thinking on constipation management. A1 - Doughty,Dorothy B, PY - 2002/12/20/pubmed PY - 2003/1/25/medline PY - 2002/12/20/entrez SP - 30 EP - 41 JF - Ostomy/wound management JO - Ostomy Wound Manage VL - 48 IS - 12 N2 - Constipation is a common disorder and many patients fail to respond to the simple constipation remedies of increased fiber and fluid intake. When secondary to other conditions, medications, or disease processes, the focus of constipation management is correction of causative factors. However, primary constipation - ie, constipation with no identifiable causative factor - is very common. Patients generally present with one of three patterns: constipation-predominant irritable bowel syndrome, slow transit constipation, or pelvic floor dysfunction resulting in dyssynergic defecation. Baseline evaluation for patients with chronic constipation includes a careful history, focused physical examination, and limited laboratory studies. Patients with dyssynergic defecation usually respond best to biofeedback therapy and pelvic muscle re-education. Constipation-predominant irritable bowel syndrome is best managed with dietary monitoring and modifications, fiber therapy, and education regarding self-monitoring and self-care. Patients with slow transit constipation may benefit from fiber therapy and increased activity, but most also will require laxative therapy. Current guidelines for prescribing laxatives suggest bulk agents as first line and osmotic agents as second line therapy. Stimulant laxatives should generally be reserved for PRN use. Current understanding about the etiology, pathology, and classification of different types of constipation are summarized and a stepwise approach to evaluation and management is presented. SN - 0889-5899 UR - https://www.unboundmedicine.com/medline/citation/12490751/When_fiber_is_not_enough:_current_thinking_on_constipation_management_ L2 - https://www.diseaseinfosearch.org/result/1885 DB - PRIME DP - Unbound Medicine ER -
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