J Neurogastroenterol Motil.
2013 Apr;19(2):149-160.
Primary Care Management of Chronic Constipation in Asia: The ANMA Chronic Constipation Tool
- Affiliations
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- 1Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore. slbclinic@gmail.com
- 2Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
- 3GI Motility Research Unit, Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
- 4Department of Primary Care and Gastroenterology, Gastro Centre Ipoh, Ipoh, Perak, Malaysia.
- 5Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
- 6Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka.
- 7Division of Gastroenterology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea.
- 8Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR.
- 9Department of Gastroenterology and Hepatology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China.
- 10Division of Gastroenterology, Taipei Veterans General Hospital; Institute of Brain Science, National Yang-Ming University Taipei, Taiwan.
- 11Department of Medicine, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan.
- 12Asian Institute of Gastroenterology, Hyderabad, India.
- 13P D Hinduja National Hospital and MRC, Mahim, Mumbai, India.
- 14Department of Gastroenterology and Hepatology, Union Hospital of Tongji Medical College, Huazhong University of Science and Techonology, Wuhan, Hubei, China.
- 15Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China.
- 16Section of Gastroenterology, Department of Internal Medicine, Medical Center Manila, Manila, Philippines.
- 17Division of Gastroenterology, Department of Internal Medicine, Cipto Mangunkusumo General Hospital/Faculty of Medicine, University of Indonesia, Jakarta, Indonesia.
Abstract
- Chronic constipation (CC) may impact on quality of life. There is substantial patient dissatisfaction; possible reasons are failure to recognize underlying constipation, inappropriate dietary advice and inadequate treatment. The aim of these practical guidelines intended for primary care physicians, and which are based on Asian perspectives, is to provide an approach to CC that is relevant to the existing health-care infrastructure. Physicians should not rely on infrequent bowel movements to diagnose CC as many patients have one or more bowel movement a day. More commonly, patients present with hard stool, straining, incomplete feeling, bloating and other dyspeptic symptoms. Physicians should consider CC in these situations and when patients are found to use laxative containing supplements. In the absence of alarm features physicians may start with a 2-4 week therapeutic trial of available pharmacological agents including osmotic, stimulant and enterokinetic agents. Where safe to do so, physicians should consider regular (as opposed to on demand dosing), combination treatment and continuous treatment for at least 4 weeks. If patients do not achieve satisfactory response, they should be referred to tertiary centers for physiological evaluation of colonic transit and pelvic floor function. Surgical referral is a last resort, which should be considered only after a thorough physiological and psychological evaluation.
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