Functional Constipation and Pelvic Floor Dysfunction

Constipation is variably defined, and its diagnosis is often arbitrary. Patients with functional constipation (FC) present with difficult, infrequent, or seemingly incomplete defecation without meeting criteria for irritable bowel syndrome. There are a variety of secondary causes of constipation, including medications that slow colonic transit. A functional defecation disorder secondary to pelvic floor dysfunction (PFD) is a common, often under-appreciated abnormality in patients presenting with constipation. While fiber supplementation and osmotic laxatives are successful for many patients with FC, the treatment of choice for PFD is pelvic floor rehabilitation (biofeedback). Therefore, a stepwise diagnostic and therapeutic approach to patients with FC based on historical and physical examination features is recommended. Clinical awareness and focused testing to identify the physiologic abnormalities underlying constipation facilitate management and improve patient outcomes.