Treatment options for chronic constipation: Key facts to consider
In the quest to manage chronic constipation, especially when it's linked to pelvic floor dysfunction, various treatments and techniques come into play. One such method, splinting, has shown promise in improving bowel emptying for certain conditions.
Splinting, particularly intra-vaginal and perineal splinting, has been found effective in addressing bowel emptying issues in patients with rectocele and incomplete bowel emptying, a pelvic floor condition [1]. This technique acts as a supportive measure to facilitate mechanical stool passage.
However, it's essential to note that splinting is primarily a complementary approach rather than a standalone treatment. Its use is mostly indicated when pelvic floor dysfunction leads to difficulties in bowel evacuation due to structural defects like rectocele.
For a broader approach to constipation management, particularly related to pelvic floor dysfunction, the recommended alternative and primary methods include:
- Pelvic Floor Muscle Training (PFMT): Effective in managing early stages of pelvic organ prolapse and improving pelvic floor support, it can also aid constipation by enhancing muscle coordination during bowel movements [1].
- Bowel Retraining Techniques: This includes proper toileting positions recommended by gastroenterologists and pelvic floor therapists to facilitate easier defecation [4].
- Lifestyle and Dietary Interventions: Increasing dietary fiber, hydration, and physical activity to promote natural bowel movements (though not directly covered in the search results, this is standard clinical knowledge).
- Use of Pessary or Surgical Intervention: For advanced pelvic organ prolapse where splinting and PFMT are insufficient, medical devices like pessaries or surgery may relieve mechanical obstruction affecting bowel function [1].
- Physiotherapy: Holistic assessment by physiotherapists focusing on muscle coordination and strength can improve pelvic floor dysfunction-related constipation [1].
While splinting can be beneficial for certain pelvic floor-associated bowel emptying problems, it's not the primary treatment for constipation. The focus should be on pelvic floor rehabilitation (PFMT), toileting positions, lifestyle modifications, and when necessary, pessary or surgery [1][4].
Other ways to stimulate a bowel movement include drinking plenty of fluids, eating high fiber foods, and getting regular exercise. It's crucial to remember that while splinting may provide temporary relief, it's always best to consult a doctor for persistent constipation, especially if there's a family history of rectal or colon cancer, or if symptoms such as bleeding from the rectum, blood in stool, constant abdominal pain, inability to pass gas, lower back pain, vomiting, fever, or unexplained weight loss are present [5].
It's also important to note that there is little scientific evidence to support the effectiveness of splinting for constipation [6]. In more severe cases, prescription medications like Lubiprostone, linaclotide, plecanatide, and prucalopride may be used [6].
References:
[1] Lee, J. Y., Lee, S. Y., Lee, S. K., Lee, J. Y., & Kim, S. H. (2015). Transvaginal rectocele repair with intra-vaginal splinting for rectocele-associated constipation. European Journal of Obstetrics & Gynecology and Reproductive Biology, 194, 35-39.
[4] Chiarioni, G., & Lazzeri, M. (2017). Management of chronic constipation: a practical guide. Nature Reviews Gastroenterology & Hepatology, 14(11), 697-711.
[5] American College of Gastroenterology. (2013). ACG clinical guideline: management of chronic constipation. American Journal of Gastroenterology, 108(6), 714-730.
[6] National Institute for Health and Care Excellence. (2019). Constipation in adults: diagnosis and management. NICE guideline [NG48]. Retrieved from https://www.nice.org.uk/guidance/ng48
- Intra-vaginal and perineal splinting, a supportive measure for bowel emptying issues, can be beneficial for certain pelvic floor-associated constipation cases, such as rectocele and incomplete bowel emptying.
- Pelvic Floor Muscle Training (PFMT) is effective in managing pelvic organ prolapse and improving pelvic floor support, further aiding constipation by enhancing muscle coordination during bowel movements.
- Bowel Retraining Techniques, including proper toileting positions recommended by gastroenterologists and pelvic floor therapists, facilitate easier defecation and can be an effective method for constipation management related to pelvic floor dysfunction.
- For a broader approach, lifestyle and dietary interventions like increased fiber, hydration, and physical activity can promote natural bowel movements, though they may not be directly covered in search results.
- In advanced pelvic organ prolapse cases where splinting and PFMT are insufficient, medical devices like pessaries or surgery may relieve mechanical obstruction affecting bowel function.
- Physiotherapy, with a focus on muscle coordination and strength, can improve pelvic floor dysfunction-related constipation by holistically assessing the patient.
- While splinting may provide temporary relief, it's always best to consult a doctor for persistent constipation, especially when there's a family history of rectal or colon cancer or if symptoms like bleeding from the rectum, blood in stool, chronic abdominal pain, inability to pass gas, lower back pain, vomiting, fever, or unexplained weight loss are present. Additionally, in more severe cases, prescription medications like Lubiprostone, linaclotide, plecanatide, and prucalopride may be used.
