What to do after laxative failure?

Constipation is a common disease that strongly impacts patients’ quality of life. However, its management can be difficult in practice. The assessment of chronic constipation in adults is primarily clinical. The interview must confirm the symptom, specify the severity and the impact; the examination must focus on the pathophysiological mechanism(s) involved. Additional examinations will only be requested in the event of doubt regarding the anomalies responsible for the constipation, or in the absence of a satisfactory response to first-line treatment. The first-line treatment of chronic constipation is based on the combination of hygienic and dietary measures and osmotic laxatives or ballasts taken over a prolonged period. In the event of rectal evacuation disorders, biofeedback rehabilitation is effective. Measuring colonic transit time, anorectal manometry, associated with an evacuation test, and defecography are useful functional examinations to clarify constipation and target treatment. The treatment of chronic constipation must always be medical as first intention. Invasive treatment of transit constipation involves total colectomy, diverting stomas and stomas for antegrade colonic irrigation. It must be a resort treatment, offered to selected patients.