Challenging problems presenting as constipation.

Patients who seek medical care for constipation present challenges which may involve communication problems, difficulties in diagnosis, lack of optimal therapy, uncorrectable underlying disorders, or psychiatric issues which complicated management. This review describes some of these challenges, and presents management approaches that may increase the likelihood of satisfactory treatment outcomes. Situations which are reviewed include the diagnostic evaluation of the new patient with constipation; syndromes of uncertain pathophysiology including irritable bowel syndrome, slow transit constipation, and pelvic floor dysfunction; constipation associated with neurologic disorders including spinal cord injury, Parkinson's disease, and multiple sclerosis; and psychiatric issues which complicate the management of constipation, including recognition of associated psychiatric diseases, unusual attitudes toward bowel function, eating disorders, and referral for psychiatric care.