Chronic constipation: From syndrome to diagnosis and effective therapy

Chronic constipation is a generally recognized medical and social problem and occupies a leading place in the number of requests for outpatient medical care among patients with a gastroenterological profile in many countries of the world. The persistent trend in recent years towards an increase in global prevalence regardless of gender, age and socioeconomic status emphasizes the relevance of studying and systematizing data on the causes of chronic constipation and optimal approaches to diagnosis in order to improve the effectiveness of treatment of patients. A particular difficulty in managing patients with chronic constipation is identifying the etiological factor due to the presence of a wide range of possible causes. This often increases the time of diagnosis and complicates the timely initiation of rational therapy. According to etiology, chronic constipation is classified as primary (functional) – an independent disease in the absence of organic or metabolic disorders and secondary – as a symptom of another pathology or associated with a known factor. In clinical practice, the majority of cases are patients with primary chronic constipation, namely, with functional constipation and irritable bowel syndrome with a predominance of constipation. The diagnostic algorithm for chronic constipation should be aimed at assessing “alarm symptoms”, excluding organic pathology and other secondary causes. This involves a thorough collection of complaints, anamnesis of the disease and life, physical examination and the appointment of the necessary laboratory and instrumental examination methods, the scope of which is determined individually. The basis of therapy for a patient with primary chronic constipation is lifestyle modification. In the absence of a positive effect from non-drug methods, it is advisable to prescribe laxatives – osmotic action as first-line therapy, stimulating or agonists of 5HT4 receptors in case of insufficient response to the former. One of the stimulant laxatives that has shown its effectiveness and a reliable safety profile in the treatment of patients with primary chronic constipation is sodium picosulfate.