Vol. 1, Issue 5 (2016)
Pathophysiology and treatment of neurogenic constipation
Author(s): Chanchal Garg, Saurabh Satija, Meenu Mehta, Nivedita, Munish Garg
Abstract: Constipation is not a life threatening condition but it deteriorates quality of life and restricts patient’s social activities, increases levels of anxiety and depression. In the condition of constipation patient may have rare evacuation ie. When faeces are evacuated less frequently than three times a week. Patient may report more subjective complaints like prolonged time of evacuation, hard stools or stools of low volume, sensation of incomplete evacuation, difficulty in expelling of even a soft stool and painful defecation. Neurogenic constipation occurs most commonly after spinal cord injury, multiple sclerosis and in Parkinson`s disease. In diagnosis, neurological and proctologic examinations are required followed by colonic transit time, defecography and anorectal manometry. Most of the patients respond positively on medical treatment. However, a small group of them requires surgical treatment in the form of either colostomy or ileostomy. Its treatment typically begins with lifestyle changes and fiber supplementation, alteration of fluid intake, dietary modification and physical activity. Patients can avail various emollient, osmotic and stimulant laxative. Newer therapies are options that may help to improve symptom relief and patient satisfaction. 5-HT4 serotonin agonist and 5-HT3 antagonist are available. The chloride channel activator lubiprostone is recently approved for the treatment.