Department of Family Medicine, Queen's University, Kingston, Ontario, Canada.
J Am Board Fam Med. 2011 Jul-Aug;24(4):436-51. doi: 10.3122/jabfm.2011.04.100272.
Chronic constipation is a common condition seen in family practice among the elderly and women. There is no consensus regarding its exact definition, and it may be interpreted differently by physicians and patients. Physicians prescribe various treatments, and patients often adopt different over-the-counter remedies. Chronic constipation is either caused by slow colonic transit or pelvic floor dysfunction, and treatment differs accordingly.
To update our knowledge of chronic constipation and its etiology and best-evidence treatment, information was synthesized from articles published in PubMed, EMBASE, and Cochrane Database of Systematic Reviews. Levels of evidence and recommendations were made according to the Strength of Recommendation taxonomy.
The standard advice of increasing dietary fibers, fluids, and exercise for relieving chronic constipation will only benefit patients with true deficiency. Biofeedback works best for constipation caused by pelvic floor dysfunction. Pharmacological agents increase bulk or water content in the bowel lumen or aim to stimulate bowel movements. Novel classes of compounds have emerged for treating chronic constipation, with promising clinical trial data. Finally, the link between senna abuse and colon cancer remains unsupported.
Chronic constipation should be managed according to its etiology and guided by the best evidence-based treatment.
慢性便秘是老年人和女性在家庭医疗实践中常见的病症。对于其确切定义，医生和患者可能有不同的理解。医生会开出各种治疗方法，而患者也经常采用不同的非处方药物。慢性便秘可能是由于结肠传输缓慢或盆底功能障碍引起的，治疗方法也因此有所不同。
为了更新我们对慢性便秘及其病因和最佳证据治疗的认识，我们从发表在 PubMed、EMBASE 和 Cochrane 系统评价数据库中的文章中综合了信息。根据推荐分级的力度（Strength of Recommendation Taxonomy）制定了证据级别和推荐意见。
增加膳食纤维、液体和运动来缓解慢性便秘的标准建议，仅对真正缺乏的患者有益。生物反馈对于由盆底功能障碍引起的便秘最有效。药物治疗通过增加肠道腔内容物的体积或水分含量，或刺激肠道运动来起作用。治疗慢性便秘的新型化合物类药物已经出现，具有有前景的临床试验数据。最后，番泻叶滥用与结肠癌之间的联系仍然没有得到支持。
应根据慢性便秘的病因进行管理，并根据最佳的循证治疗方法进行指导。
