Summary of the Seoul Consensus on Functional Constipation
| Level of evidence | Strength of recommendation | ||
|---|---|---|---|
| Definition and epidemiology | |||
| 1 | Constipation is defined as the occurrence of symptoms of infrequent bowel movements, hard stools, a feeling of incomplete evacuation, straining at defecation, a sense of anorectal blockage during defecation, and use of digital maneuvers to assist defecation. | NA | NA |
| 2 | The prevalence of constipation is higher in the elderly population. | Moderate | NA |
| 3 | The prevalence of constipation is higher in females than in males. | High | NA |
| Diagnosis | |||
| 4 | Type 1 and 2 stools (according to the Bristol Stool Form Scale) can be used to predict slow-transit constipation in patients with chronic constipation. | Moderate | Conditional |
| 5 | Digital rectal examination is useful for identifying organic anorectal causes of constipation (such as anorectal masses, rectal prolapse, and rectoceles). | Moderate | Strong |
| 6 | Abnormal findings on digital rectal examination, suggesting defecatory disorders, can prompt the referral for physiological tests. | Moderate | Strong |
| 7 | Colonoscopy should be performed in patients with constipation who have alarm symptoms or have not undergone appropriate colon cancer screening. | Low | Strong |
| 8 | Physiological tests are recommended for patients with functional constipation who have failed to respond to treatment with available laxatives (for a minimum of 12 weeks and under a recommended therapeutic regimen) or who are strongly suspected of having a defecatory disorder. | Very low | Strong |
| 9 | Although poorly standardized, the balloon expulsion test may be useful for screening for defecatory disorders. | Moderate | Conditional |
| 10 | Anorectal manometry is useful for diagnosing defecatory disorders in patients with constipation. However, it should be performed alongside other anorectal physiological tests to confirm the diagnosis. | Moderate | Strong |
| 11 | Defecography is useful for assessing structural abnormality of the pelvic floor or pelvic dyssynergia in patients with chronic constipation who are suspected of having an evacuation disorder. | Moderate | Strong |
| 12 | Segmental colon transit time is useful for differentiating slow-transit constipation from defecatory disorder in patients with chronic constipation. | Low | Strong |
| Management | |||
| 13 | Dietary fiber is effective in improving the symptoms of chronic constipation by reducing the colon transit time and increasing the bowel frequency. | Moderate | Strong |
| 14 | Exercises can be recommended since they may improve symptoms in some patients with chronic constipation. Besides, exercises confer health benefits to people of all age groups. | Low | Conditional |
| 15 | Bulking agents increase the frequency of defecation and are effective and safe for the management of chronic constipation. | Moderate | Strong |
| 16 | The use of bulking agents, especially insoluble fiber, in patients with chronic constipation is limited by adverse events, particularly abdominal pain, bloating, flatulence, and nausea. | Low | Conditional |
| 17 | Magnesium salts improve stool frequency and consistency. | High | Strong |
| 18 | Magnesium salts can cause hypermagnesemia in patients with an impaired renal function. | Low | Strong |
| 19 | Non-absorbable carbohydrates are effective in patients with chronic constipation. | Low | Strong |
| 20 | Long-term administration and use in elderly patients of non-absorbable carbohydrates may be considered as serious side effects are rare. | Low | Conditional |
| 21 | Polyethylene glycol is effective in the management of chronic constipation. | High | Strong |
| 22 | Polyethylene glycol is safe and tolerable for long-term treatment in patients with chronic constipation and can be considered for use in the elderly. | Moderate | Conditional |
| 23 | The administration of stimulant laxatives is recommended to relieve symptoms in patients with chronic constipation. | Moderate | Strong |
| 24 | The use of stimulant laxatives in patients with chronic constipation should be recommended for a short-term period due to limited evidence on the long-term safety of these laxatives. | Low | Conditional |
| 25 | Probiotics can be used to relieve constipation symptoms in patients with chronic constipation. However, because the effects of probiotics vary depending on their species/strains and because the results between studies are inconsistent, it is recommended to use probiotics as a supplementary treatment. | Low | Conditional |
| 26 | Prucalopride is a highly selective serotonin (5-hydroxytryptamine)-4 agonist that accelerates the whole gut motility. It is effective in the management of chronic constipation, even in patients who exhibit an inadequate response to conventional laxatives. | High | Strong |
| 27 | Lubiprostone, the chloride channel activator, is effective and safe for the management of chronic constipation. It does not cause clinically significant adverse effects, such as electrolyte imbalance and renal dysfunction. | High | Strong |
| 28 | Linaclotide, an intestinal secretagogue, is effective and safe for the management of chronic constipation. | High | Strong |
| 29 | Biofeedback therapy is effective and safe for treating patients with defecatory disorders. | Moderate | Strong |
| 30 | Biofeedback therapy has long-term therapeutic effects and improves the quality of life in patients with defecatory disorders. | Moderate | Strong |
| 31 | Enemas can be effective in the subset of patients with refractory defecatory disorders. | Low | Conditional |
| 32 | Enemas should be used with caution because there are no standardized guidelines on their use and they may cause adverse events, such as electrolyte imbalance and rectal mucosal injury. | Low | Conditional |
| 33 | Colectomy can be considered in highly selected patients with medically intractable (non-responsive) slow-transit constipation who do not have defecatory disorders and other gastrointestinal motility disorders. | Moderate | Conditional |
| 34 | Surgery for obstructed defecation syndrome can be indicated in patients with reparable structural abnormalities (such as rectocele, rectal intussusception, or rectal prolapse). | Low | Conditional |
NA, not applicable.