Monitoring
- Treatment failure of constipation is suspected if any one of the following is present during the last 1-2 weeks:
- No improvement in stool consistency on current treatment
- Insufficient improvement of other signs and symptoms of chronic constipation on current treatment
- Need to strain on most occasions or straining is getting worse
- Inadequate bowel movements most of the time as reported by patient and <3 days/week complete bowel movements
- Poor tolerance to current therapy making the relief provided unacceptable
If a patient with chronic constipation does not respond to conventional therapy, he/she should be evaluated for slow transit constipation, pelvic floor dysfunction, and other evacuation disorders or disorders of anorectal musculature. The patient may also be referred for psychological evaluation for possible biofeedback therapy. Biofeedback is a technique wherein patients are taught to relax their pelvic floor muscles while straining. It is the cornerstone for pelvic floor dysfunction management and may be considered only in patients with functional defecatory disorders. Behavioral treatments, including psychotherapy may improve a patient’s quality of life and coping in functional constipation but further studies are needed to determine its specific effect on constipation. Chronic constipation is refractory when symptoms persist after a 4-week trial of medical therapy for each drug or a 3-month trial of pelvic floor behavioral therapy.