An approach to constipation associated with pelvic floor dysfunction

Constipation is usually characterized by infrequent defecation, straining, hard stools and feelings of incomplete evacuation. It is essential to distinguish between acute and chronic constipation. Primary constipation maybe classified as normal transit constipation, slow transit constipation or anorectal dysfunction, which can be either due to ansimus or abnormal perineal descent.A detailed history and physical examination is necessary. Tests of colonic and pelvic floor function help distinguish constipation due to transit problems from that due to anorectal dysfunction. Patients can be divided into 4 main groups: Slowtransit constipation, pelvic floor dysfunction, combined (slow-transit and pelvic floor dysfunction) and normal transit constipation. A small group of patients, refractory to medical therapy should be considered for surgery. Should test results show pelvic floor dysfunction, then behavioural modifications such as biofeedback is successful in up to 76% of patients. Analgorithmic approach to treatment is associated with an excellent long term outcome.