Evidence-Based Update on Unplugging the Clog-Evidence-Based Update on Unplugging the Clog

Video Transcription

Video Summary

The webinar, led by Dr. Holly Richter and moderated by Dr. Christine Vaccaro, focused on an evidence-based, practical approach to evaluating and treating constipation in women. Dr. Richter emphasized that constipation is common, especially in women, and can significantly affect quality of life.<br /><br />She reviewed how constipation is defined, noting that stool frequency alone is not enough to diagnose it. Instead, Rome IV criteria require at least two symptoms such as straining, hard stools, incomplete evacuation, blockage, manual maneuvers, or fewer than three spontaneous bowel movements weekly, along with chronicity requirements. She also explained the major categories of constipation: primary constipation (including normal transit, slow transit, and defecatory disorders like dyssynergic defecation) and secondary constipation caused by medications, metabolic disease, neurologic disorders, mechanical obstruction, and other reversible factors.<br /><br />Dr. Richter walked through normal colon physiology, diagnostic evaluation, and the importance of a focused history and physical exam, especially digital rectal exam. She described testing options such as anorectal manometry, balloon expulsion testing, defecography, and transit studies, reserving more advanced testing for refractory cases or when a structural or functional disorder is suspected.<br /><br />Treatment was presented as stepwise and individualized: reassurance, diet/fluid/exercise changes, fiber, osmotic and stimulant laxatives, then targeted therapies such as biofeedback for dyssynergia, medications like secretagogues or prokinetics, and surgery only for carefully selected severe cases. The Q&A addressed rectocele plus dyssynergia, squatty potty use, pelvic floor behavior change, perineal descent, probiotics, GLP-1 medications, and sacral neuromodulation.

Meta Tag

Concept Chronic Constipation

Concept Constipation Evaluation

Concept Rectal Examination

Concept Constipation Management

Concept Rome IV Criteria

Keywords

constipation

women's health

Rome IV criteria

dyssynergic defecation

anorectal manometry

balloon expulsion test

defecography

transit studies

biofeedback therapy

laxatives

Chronic Constipation

Constipation Evaluation

Rectal Examination

Constipation Management

Rome IV Criteria