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World J Gastroenterol. Apr 14, 2012; 18(14): 1555-1564
Published online Apr 14, 2012. doi: 10.3748/wjg.v18.i14.1555
Consensus statement AIGO/SICCR: Diagnosis and treatment of chronic constipation and obstructed defecation (part I: Diagnosis)
Antonio Bove, Filippo Pucciani, Massimo Bellini, Edda Battaglia, Renato Bocchini, Donato Francesco Altomare, Giuseppe Dodi, Guido Sciaudone, Ezio Falletto, Vittorio Piloni, Dario Gambaccini, Vincenzo Bove
Antonio Bove, Vincenzo Bove, Gastroenterology and Endoscopy Unit, Department of Gastroenterology, AORN “A. Cardarelli”, 80131 Naples, Italy
Filippo Pucciani, Department of Medical and Surgical Critical Care, University of Florence, 50141 Florence, Italy
Massimo Bellini, Dario Gambaccini, Gastrointestinal Unit, Department of Gastroenterology, University of Pisa, 56100 Pisa, Italy
Edda Battaglia, Gastroenterology and Endoscopy Unit, Cardinal Massaja Hospital, 14100 Asti, Italy
Renato Bocchini, Gastroenterology Unit, M. Bufalini Hospital, 47023 Cesena, Italy
Donato Francesco Altomare, Department of Emergency and Organ Transplantation, University of Bari, 70124 Bari, Italy
Giuseppe Dodi, Department of Oncological and Surgical Sciences, University of Padua, 35126 Padua, Italy
Guido Sciaudone, Division of General and Geriatric Surgery, Second University of Naples, 80131 Naples, Italy
Ezio Falletto, Sixth Division of University Surgery, Department of General Surgery, San Giovanni Battista Hospital, 10126 Turin, Italy
Vittorio Piloni, Diagnostic Imaging Centre “N. Aliotta”, Villa Silvia - Senigallia, I-60100 Ancona, Italy
Author contributions: Bove A, Pucciani F and Bellini M contributed to the study concept and design; Battaglia E, Bocchini R, Altomare DF, Dodi G, Sciaudone G, Falletto E and Piloni V collected data and wrote the manuscript; the manuscript was revised by Gambaccini D and Bove V; all authors read and approved the paper.
Supported by Associazione Italiana Gastroenterologi and Endoscopisti Digestivi Ospedalieri via N Colajanni, 4 - 00191 Roma, Italy; and Società Italiana di Chirurgia Colo-Rettale via Medici, 23 - 10143 Torino, Italy
Correspondence to: Antonio Bove, MD, Gastroenterology and Endoscopy Unit, Department of Gastroenterology, AORN “A. Cardarelli”, Via Cardarelli, 9, 80131 Naples, Italy. 3392982380@fastwebnet.it
Telephone: +39-81-7474034 Fax: +39-81-7474034
Received: July 31, 2011
Revised: October 21, 2011
Accepted: March 10, 2012
Published online: April 14, 2012

Chronic constipation is a common and extremely trou-blesome disorder that significantly reduces the quality of life, and this fact is consistent with the high rate at which health care is sought for this condition. The aim of this project was to develop a consensus for the diagnosis and treatment of chronic constipation and obstructed defecation. The commission presents its results in a “Question-Answer” format, including a set of graded recommendations based on a systematic review of the literature and evidence-based medicine. This section represents the consensus for the diagnosis. The history includes information relating to the onset and duration of symptoms and may reveal secondary causes of constipation. The presence of alarm symptoms and risk factors requires investigation. The physical examination should assess the presence of lesions in the anal and perianal region. The evidence does not support the routine use of blood testing and colonoscopy or barium enema for constipation. Various scoring systems are available to quantify the severity of constipation; the Constipation Severity Instrument for constipation and the obstructed defecation syndrome score for obstructed defecation are the most reliable. The Constipation-Related Quality of Life is an excellent tool for evaluating the patient‘s quality of life. No single test provides a pathophysiological basis for constipation. Colonic transit and anorectal manometry define the pathophysiologic subtypes. Balloon expulsion is a simple screening test for defecatory disorders, but it does not define the mechanisms. Defecography detects structural abnormalities and assesses functional parameters. Magnetic resonance imaging and/or pelvic floor sonography can further complement defecography by providing information on the movement of the pelvic floor and the organs that it supports. All these investigations are indicated to differentiate between slow transit constipation and obstructed defecation because the treatments differ between these conditions.

Keywords: Slow transit constipation, Dyssynergic defecation, Obstructed defecation, Constipation scoring system, Quality of life, Anorectal manometry, Colon motility, Balloon expulsion test, Defecography