Primary Care Management of Chronic Constipation in Asia: The ANMA Chronic Constipation Tool.
- Author:
Kok Ann GWEE
1
;
Uday C GHOSHAL
;
Sutep GONLACHANVIT
;
Andrew Seng Boon CHUA
;
Seung Jae MYUNG
;
Shaman RAJINDRAJITH
;
Tanisa PATCHARATRAKUL
;
Myung Gyu CHOI
;
Justin C Y WU
;
Min Hu CHEN
;
Xiao Rong GONG
;
Ching Liang LU
;
Chien Lin CHEN
;
Nitesh PRATAP
;
Philip ABRAHAM
;
Xiao Hua HOU
;
Meiyun KE
;
Jane D RICAFORTE-CAMPOS
;
Ari Fahrial SYAM
;
Murdani ABDULLAH
Author Information
1. Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore. slbclinic@gmail.com
- Publication Type:Review
- Keywords:
Asia;
Constipation;
Management;
Physicians, primary care
- MeSH:
Asia;
Asian Continental Ancestry Group;
Colon;
Constipation;
Health Resorts;
Humans;
Pelvic Floor;
Physicians, Primary Care;
Primary Health Care;
Quality of Life;
Referral and Consultation;
Sprains and Strains
- From:Journal of Neurogastroenterology and Motility
2013;19(2):149-160
- CountryRepublic of Korea
- Language:English
-
Abstract:
Chronic constipation (CC) may impact on quality of life. There is substantial patient dissatisfaction; possible reasons are failure to recognize underlying constipation, inappropriate dietary advice and inadequate treatment. The aim of these practical guidelines intended for primary care physicians, and which are based on Asian perspectives, is to provide an approach to CC that is relevant to the existing health-care infrastructure. Physicians should not rely on infrequent bowel movements to diagnose CC as many patients have one or more bowel movement a day. More commonly, patients present with hard stool, straining, incomplete feeling, bloating and other dyspeptic symptoms. Physicians should consider CC in these situations and when patients are found to use laxative containing supplements. In the absence of alarm features physicians may start with a 2-4 week therapeutic trial of available pharmacological agents including osmotic, stimulant and enterokinetic agents. Where safe to do so, physicians should consider regular (as opposed to on demand dosing), combination treatment and continuous treatment for at least 4 weeks. If patients do not achieve satisfactory response, they should be referred to tertiary centers for physiological evaluation of colonic transit and pelvic floor function. Surgical referral is a last resort, which should be considered only after a thorough physiological and psychological evaluation.
