Functional constipation, as per Rome IV criteria, must include ≥2 of the following: straining during more than one-fourth (25%) of defecations, lumpy/hard stools (BSFS 1,2) more than one-fourth (25%) of defecations, sensation of incomplete evacuation more than one-fourth (25%) of defecations, sensation of anorectal obstruction more than one-fourth (25%) of defecations, manual maneuvers to facilitate more than onefourth (25%) of defecations and fewer than 3 spontaneous bowel movements per week. Loose stools are rarely present without the use of laxative and insuffi cient criteria for IBS.

Other drugs such as elobixibat (inhibitor of ileal bile acid transporter), tenapanor (inhibitor of Na-H exchanger isoform 3 [NHE3]), colchicine, misoprostol, pyridostigmine have been used in chronic constipation.

Vibrating capsule treatment for chronic constipation was superior to placebo capsule in improving symptoms of constipation and quality of life in a phase 3, doubleblind, multicenter, placebo-controlled trial of patients with chronic constipation. It was safe and well-tolerated.

EKG for the gut: The 6-day wireless motility patch system (WPS) measures myoelectrical signals from the stomach, intestine and colon over multiple days. In patients with predominant satisfactory bowel motions, increased night time (vs. daytime) colon activity was seen. Whereas in patients with predominant unsatisfactory bowel motions, reduced night time colonic activity was observed.

New tests for constipation include anorectal manometry (high-resolution manometry [HRM], 3D HRM, machine learning tools - artifi cial intelligence) and colon motility testing (colon transit study, smart pill, HRM colonic manometry and WPS).

 When everything has failed in refractory constipation, other measures such as transanal irrigation (Peristeen device), colonic resections (ileostomy, ileorectal anastomosis), sacral nerve stimulation and tibial nerve stimulation may be used.


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