Constipation is not a mood disorder

New Guideline "Chronic constipation"

About 10 15 to percent of German adults suffer from chronic constipation. Women in particular struggle with bloating, bloating and disturbed defecation. The German Society of Digestive and Metabolic Diseases (DGVS) has now been published in cooperation with the German Society of Neurosurgery and Motility (DGNM) a guideline for chronic constipation. For an effective treatment, the experts recommend the use of a phasing-in mechanism: from high-fiber diet is sufficient the treatment plan on the various medicines to Operation.

"The recommendation for surgery is of course the absolute exception," said Guidelines Co-ordinator Dr. med. Viola Andresen, senior physician at the Medical Clinic at the Jewish Hospital, Hamburg. A removal of the colon or the use of an intestinal pacemaker would - if at all - only a few patients in question under the most severe form of constipation, a so-called intestinal paralysis, suffer and which helps no other therapy.

Chronic constipation is according to the new guidelines before when patients for at least three months suffer from "unsatisfactory defecation" and added two more Keynotes. This may for example be "hard pressing", "Chunky hard stool" or "subjectively incomplete emptying".

Important in the choice of therapy is the distinction between a mechanically or functionally related defecation disorder and a transport disorder of the intestine; whereby both can coexist. As basic therapy of stage plan recommends first to examine the lifestyle: The patient should pay attention to high-fiber diet, drink plenty of fluids and exercise regularly. "To supplement the diet with psyllium husk and wheat bran, is certainly worth a try," says Andresen. The recommendations on drinking and exercise habits, however, have their limits: "More than a half to two liters a day to drink or exercise beyond measure, proves to have no therapeutic effect," says the scientist.

Executes the lifestyle and dietary changes are not successful, the doctors are a number of medications available today. When intestinal transport disturbances, the authors of the guideline recommended as the first choice different drugs in the field of classical laxatives (macrogol, bisacodyl, Natriumpicosulfat), which provide, among other things, that the chair is smoother and plumper and the intestine is excited thereby. These preparations can also be used in the long term.

Alternatively come sugars or "anthraquinones" into consideration while salt based agents and oils are less desirable because of potential side effects. "If necessary, the patient must change the preparation or try a combination therapy," says Andresen. Rich not from these measures, the use of prokinetic agents is useful. These are drugs that stimulate the movement of the intestine directly in the intestinal nervous system. When defecation disturbances coming supportive addition to a targeted therapy of voiding dysfunction laxative or enemas used.

With the guideline the DGVS allows physicians and patients a treatment according to the latest scientific findings. "Our concern is that chronic constipation is taken seriously as a disease is because it is often associated with very great suffering associated" says Andresen. "The common perception that it is a commonplace - perhaps self-inflicted - is mood disorder is now scientifically disproved."

Literature:

S2k guideline Chronic constipation: definition, pathophysiology, diagnosis and treatment, Joint Guideline of the German Society of Neurosurgery and Motility (DGNM) and the German Society of Digestive and Metabolic Diseases (DGVS)

Z Gastroenterol 2013; 51 (7): 651-672, Georg Thieme Verlag, Stuttgart.

The guidelines on the Internet: http://www.dgvs.de/2659.php 

Source: Berlin [DGVS / DGMN]