The second part of the Consensus Statement of the
Italian Association of Hospital Gastroenterologists
and Italian Society of Colo-Rectal Surgery reports on
the treatment of chronic constipation and obstructed
defecation. There is no evidence that increasing fluid
intake and physical activity can relieve the symptoms
of chronic constipation. Patients with normal-transit
constipation should increase their fibre intake through
their diet or with commercial fibre. Osmotic laxatives
may be effective in patients who do not respond to
fibre supplements. Stimulant laxatives should be reserved
for patients who do not respond to osmotic
laxatives. Controlled trials have shown that serotoninergic
enterokinetic agents, such as prucalopride, and
prosecretory agents, such as lubiprostone, are effective
in the treatment of patients with chronic constipation.
Surgery is sometimes necessary. Total colectomy
with ileorectostomy may be considered in patients
with slow-transit constipation and inertia coli who are
resistant to medical therapy and who do not have
defecatory disorders, generalised motility disorders or
psychological disorders. Randomised controlled trials
have established the efficacy of rehabilitative treatment
in dys-synergic defecation. Many surgical procedures
may be used to treat obstructed defecation in
patients with acquired anatomical defects, but none is
considered to be the gold standard. Surgery should be
reserved for selected patients with an impaired quality
of life. Obstructed defecation is often associated with
pelvic organ prolapse. Surgery with the placement of
prostheses is replacing fascial surgery in the treatment
of pelvic organ prolapse, but the efficacy and safety of
such procedures have not yet been established