[Pathophysiology of chronic constipation and new therapy recommendation].

Three causes of constipation are known: Chagas' disease, congenital megacolon (Hirschsprung's disease) and continent obstipation. Those diseases are rare, they can be treated successfully by drugs, surgery or psychotherapy. More common is the idiopathic chronic constipation, observed manly in females. A frequent cause is the laxative abuse for many years. The possible etiologic factors are discussed. Based on the fact, that constipation never occurs in patients with a colostomy, reasons for the development of chronic idiopathic constipation are presumed in a disturbance in the distal colon and the anorectum. A possible explanation for the malfunction of defecation could be a different calibre between the usually tight pelvic colon and the wide rectum. In contrast to the apolar structure of the large bowel, the rectum shows a polar fibrous configuration. An additional disorder in the feedback mechanism between continence and defecation could impede the bowel passage. Because of these observations and thoughts, we performed a deep resection of the rectum in 18 patients instead of resecting the dilated and elongated colon. All patients operated that way experienced a major improvement of their bowel function. Postoperatively the bowel movements were regular and normal.