[Impact of chronic constipation on quality of life: Much more important than it seems]

High-Resolution Anorectal Manometry - New Insights in the Diagnostic Assessment of Functional Anorectal Disorders

Functional anorectal disorders such as faecal incontinence (FI), functional anorectal pain, and functional defecation disorders (FDD) are highly prevalent and represent a high socioeconomic burden. Several tests of anorectal function exist in this setting; however, high-resolution anorectal manometry (HR-ARM) is a new tool that depicts pressure all along the anal canal and can assess rectoanal coordination. HR-ARM is used in the diagnosis of FI and especially FDD although data in health is still sparse, and pressure phenomena seen during simulated defecation, such as dyssynergia, are highly prevalent in health.

Efficacy of chronic disease management in chronic constipation patients with different ages

AIM

To assess the efficacy of chronic disease management (CDM) in chronic constipation (CC) patients with different ages.

METHODS

Seven hundred and sixteen patients with CC treated at the First Hospital of Shanxi Medical University were divided into young, middle-aged and elderly groups according to age and asked to complete a questionnaire, based on which we designed a comprehensive management plan for patients with individual characteristics. A concept called "CDM" was used to give individualized interventions involving diet, exercise, and defection management. The patients were followed for a total of 6 mo (28 d per month), and during this period, a "defecation dairy" was performed to record the symptoms. Bowel symptoms, concomitant symptoms, laxative use and symptom improvement were compared and evaluated before and after the intervention.

RESULTS

After intervention, the defecation frequency, fecal character and the degree of difficulty in defecation were improved significantly (P < 0.01); concomitant symptoms in young and middle-aged patients were relieved (P < 0.05), but the elderly group had no significant changes (P > 0.05); laxative dependence was significantly lower (P < 0.01); and constipation was significantly improved (P < 0.05).

CONCLUSION

Individualized intervention based on CDM mode can effectively relieve bowel symptoms and concomitant symptoms, reduce laxative use, and improve constipation in patients with CC.

Chronic constipation and chronic disease management

Urbanization, population aging and lifestyle changes have resulted in great changes in global disease pattern and medical model. Chronic non-communicable diseases have become the main cause of premature death around the world in the 21^st century, and their prevention and control have also changed from "treatment" to "management". As a result, chronic disease management (CDM) model arises. Chronic constipation (CC) has a hidden onset, complex etiology, prolonged course, and high prevalence, and it can induce a variety of diseases and affect the quality of life seriously. Mainstream therapy for CC is empirical treatment for facilitating feces excretion, but it may lead to more serious symptoms. Application of the CDM model to CC management may solve this problem. In the current review, we will discuss the progress in research of CC and the current status of CDM.