THE MANAGEMENT OF CONSTIPATION IN ADULTS

The successful management of constipation depends on defining the pati ent's symptoms, excluding secondary causes, and characterizing the abn ormality of defecation. Constipation without gut dilatation is found c ommonly in pregnancy, the elderly, and those with the irritable bowel syndrome. In addition, there is a group of patients that has intractab le, severe idiopathic constipation. Some have 'slow transit' and open their bowels every 1-4 weeks. Others have a defecatory disorder with n ormal colonic transit. Constipation with gut dilatation is seen in Hir schsprung's disease, idiopathic megarectum and megacolon, chronic inte stinal pseudo-obstruction and Chagas' disease. Constipation can also r esult from disturbance to the autonomic outflow of the gastrointestina l tract, and colonic function may be also affected by psychological fa ctors. This review article discusses the presentation, investigation a nd management of patients with constipation.