Idiopathic Constipation and Other Motility Disorders

  • Alberto Peña
  • Andrea Bischoff


The methods of evaluation of patients with severe constipation including nuclear transit studies, sitz markers, ultrasound, and rectal manometry are critically discussed. The authors offer their original way to evaluate the magnitude of the constipation problem, based on the amount of senna laxative, necessary to empty the colon completely, as radiologically demonstrated.

The literature is abundant in different methods to deal with this problem, including psychotherapy, physiotherapy, biofeedback, dietetic measures, electrical simulation, and Botox injections. All these alternatives are critically discussed. The authors present their concepts related with the management of constipation. These concepts are based on the fact that this condition is incurable but manageable and that it is represented by a spectrum in terms of severity. In other words, constipation may be minimal and easy to manage or may appear with different degrees of severity to the point to overlap with the problem known as “intestinal pseudo-obstruction,” and therefore each patient will need a different type of treatment. The principles of the author’s management are also based on the fact that the best way to monitor the amount of stool in the colon as a response to the different treatments is by taking abdominal x-ray films.

A protocol of management of idiopathic constipation is presented in this chapter. The protocol is based on the fact that every patient is different and needs a different amount of laxatives that can only be determined by trial and error. In the authors’ experience, 15 % of patients do not respond to this medical management and require an operation. A critical discussion is presented by the different surgical procedures and methods used by different authors including myectomy, Malone procedure, and colonic resections.


Botulinum Toxin Anal Canal Bowel Movement Internal Sphincter Contrast Enema 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Supplementary material

Animation 25.1

Animation showing the disimpaction process (WMV 37952 kb)


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Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  • Alberto Peña
    • 1
  • Andrea Bischoff
    • 1
  1. 1.Pediatric SurgeryColorectal Center for Children Cincinnati Children’s HospitalCincinnatiUSA

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