Medical treatment of irritable bowel syndrome, constipation, and obstructed defecation

Abstract

The treatment of bowel dysfunction is a common medical challenge, due to the high prevalence and complexity of constipation among the populations of western countries. The aim of this chapter is to point out the main elements of the medical treatment of the bowel functional disorders that may afflict the pelvic floor. Irritable bowel syndrome (IBS) may feature constipation (IBS-C) or diarrhea (IBS-D) as predominant dysfunction, or even alternating symptoms (IBS-A). IBS can be treated with traditional therapies (antidiarrheals, dietary modifications, fiber supplementation, bulking agents, osmotic laxatives, tricyclic antidepressants, and antispasmodics). Currently, evaluation of new agents (agonists and antagonists of serotonin receptors, adrenergic modulators, chloride channel activators, probiotics, and others) is in progress. The treatment of slow transit constipation (STC) may feature therapy of the comorbidities that may result in constipation - dietary suggestions, lifestyle changes, correction of bowel habits, and laxatives, but new agents are also taken in consideration. Obstructed defecation (OD) can be treated by aiming to decrease the consistency of the stool and facilitate rectal evacuation. Many patients affected by OD and correctly treated with conservative therapies can obtain relief from their symptoms and avoid surgical treatment. © 2010 Springer-Verlag Milan.