Constipation and Functional Bowel Disorders

  • Madhulika G. Varma
  • Brooke H. Gurland


Constipation is one of the most common complaints voiced to primary care physicians, internists, gastroenterologists, and colorectal surgeons alike, with prevalence in North America estimated between 2 and 27%.1,2 This broad range reflects a lack of agreement between how patients and physicians perceive constipation because definitions are variable and may refer to infrequent or hard bowel movements, or to difficulty with evacuation. In addition, complaints of constipation are two to three times more common in women than men. Knowles et al. reported that of 2,004 patients evaluated by transit study at three European tertiary referral centers for intractable constipation, 92% were women.3 In a cohort of 2,000 women aged 40–69 years, 60% self-reported symptoms of difficult rectal evacuation over the last 12 months while 12% reported these symptoms weekly.4 This difference can be explained by the vast diversity of how women define normal female bowel habits. Zutshi et al.5 identified that women were more inclined to view their own habits as normal and perceive other habits unlike theirs as abnormal through self-reported questionnaires.



This chapter was authored by Amanda Metcalf and Howard Michael Ross in the previous edition of this textbook.


  1. 1.
    Higgins PD, Johanson JF. Epidemiology of constipation in North America: a systematic review. Am J Gastroenterol. 2004;99(4):750–9.PubMedGoogle Scholar
  2. 2.
    Sonnenberg A, Koch TR. Epidemiology of constipation in the United States. Dis Colon Rectum. 1989;32(1):1–8.PubMedGoogle Scholar
  3. 3.
    Knowles CH, Scott SM, Rayner C, Glia A, Lindberg G, Kamm MA, et al. Idiopathic slow-transit constipation: an almost exclusively female disorder. Dis Colon Rectum. 2003;46(12):1716–7.PubMedGoogle Scholar
  4. 4.
    Varma MG, Hart SL, Brown JS, Creasman JM, Van Den Eeden SK, Thom DH. Obstructive defecation in middle-aged women. Dig Dis Sci. 2008;53(10):2702–9.PubMedPubMedCentralGoogle Scholar
  5. 5.
    Zutshi M, Hull TL, Bast J, Hammel J. Female bowel function: the real story. Dis Colon Rectum. 2007;50(3):351–8.PubMedGoogle Scholar
  6. 6.
    Talley NJ, Fleming KC, Evans JM, O’Keefe EA, Weaver AL, Zinsmeister AR, et al. Constipation in an elderly ­community: a study of prevalence and potential risk factors. Am J ­Gastroenterol. 1996;91(1):19–25.PubMedGoogle Scholar
  7. 7.
    Drossman DA, Corazziari E, Talley NJ, Thompson WG, Whitehead WE, editors. ROME III. The functional gastrointestinal disorders diagnosis, pathophysiology, and treatment. A multinational consensus. 2nd ed. McLean, VA: Degnon Associates; 2000.Google Scholar
  8. 8.
    Lewis SJ, Heaton KW. Stool form scale as a useful guide to intestinal transit time. Scand J Gastroenterol. 1997;32(9):920–4.PubMedGoogle Scholar
  9. 9.
    Devroede G. Psychophysiological considerations in subjects with chronic idiopathic constipation. In: Wexner SD, Bartolo DC, editors. Constipation: etiology, evaluation and management. 1st ed. Oxford, UK: Butterworth-Heinemann; 1995. p. 103.Google Scholar
  10. 10.
    Hinton JM, Lennard-Jones JE, Young AC. A new method for studying gut transit times using radioopaque markers. Gut. 1969;10(10):842–7.PubMedPubMedCentralGoogle Scholar
  11. 11.
    Martelli H, Devroede G, Arhan P, Duguay C, Dornic C, Faverdin C. Some parameters of large bowel motility in normal man. Gastroenterology. 1978;75(4):612–8.PubMedGoogle Scholar
  12. 12.
    Metcalf AM, Phillips SF, Zinsmeister AR, MacCarty RL, Beart RW, Wolff BG. Simplified assessment of segmental colonic transit. Gastroenterology. 1987;92(1):40–7.PubMedGoogle Scholar
  13. 13.
    Cowlam S, Khan U, Mackie A, Varma JS, Yiannankou Y. Validity of segmental transit studies used in routine clinical practice, to characterize defaecatory disorder in patients with functional constipation. Colorectal Dis. 2008;10(8):818–22.PubMedGoogle Scholar
  14. 14.
    Bonapace ES, Maurer AH, Davidoff S, Krevsky B, Fisher RS, Parkman HP. Whole gut transit scintigraphy in the clinical evaluation of patients with upper and lower gastrointestinal symptoms. Am J Gastroenterol. 2000;95(10):2838–47.PubMedGoogle Scholar
  15. 15.
    Maqbool S, Parkman HP, Friedenberg FK. Wireless capsule motility: comparison of the SmartPill GI monitoring system with scintigraphy for measuring whole gut transit. Dig Dis Sci. 2009;54(10):2167–74.PubMedGoogle Scholar
  16. 16.
    Fleshman JW, Dreznik Z, Cohen E, Fry RD, Kodner IJ. Balloon expulsion test facilitates diagnosis of pelvic floor outlet obstruction due to nonrelaxing puborectalis muscle. Dis Colon Rectum. 1992;35(11):1019–25.PubMedGoogle Scholar
  17. 17.
    Jorge JM, Wexner SD, Ger GC, Salanga VD, Nogueras JJ, Jagelman DG. Cinedefecography and electromyography in the diagnosis of nonrelaxing puborectalis syndrome. Dis Colon Rectum. 1993;36(7):668–76.PubMedGoogle Scholar
  18. 18.
    Bertschinger KM, Hetzer FH, Roos JE, Treiber K, Marincek B, Hilfiker PR. Dynamic MR imaging of the pelvic floor performed with patient sitting in an open-magnet unit versus with patient supine in a closed-magnet unit. Radiology. 2002;223(2):501–8.PubMedGoogle Scholar
  19. 19.
    Rao SS, Seaton K, Miller M, Brown K, Nygaard I, Stumbo P, et al. Randomized controlled trial of biofeedback, sham feedback, and standard therapy for dyssynergic defecation. Clin Gastroenterol Hepatol. 2007;5(3):331–8.PubMedGoogle Scholar
  20. 20.
    Romano G, Bianco F, Caggiano L. Modified perineal stapled rectal resection with contour transtar for full-thickness rectal prolapse. Colorectal Dis. 2009;11(8):878–81.PubMedGoogle Scholar
  21. 21.
    Boccasanta P, Venturi M, Stuto A, Bottini C, Caviglia A, Carriero A, et al. Stapled transanal rectal resection for outlet obstruction: a prospective, multicenter trial. Dis Colon Rectum. 2004;47(8):1285–96. discussion 1296–7.PubMedGoogle Scholar
  22. 22.
    Ommer A, Albrecht K, Wenger F, Walz MK. Stapled transanal rectal resection (STARR): a new option in the treatment of obstructive defecation syndrome. Langenbecks Arch Surg. 2006;391(1):32–7.PubMedGoogle Scholar
  23. 23.
    Frascio M, Stabilini C, Ricci B, Marino P, Fornaro R, De Salvo L, et al. Stapled transanal rectal resection for outlet obstruction syndrome: results and follow-up. World J Surg. 2008;32(6):1110–5.PubMedGoogle Scholar
  24. 24.
    Arroyo A, Gonzalez-Argente FX, Garcia-Domingo M, Espin-Basany E, De-la-Portilla F, Perez-Vicente F, et al. Prospective multicentre clinical trial of stapled transanal rectal resection for obstructive defaecation syndrome. Br J Surg. 2008;95(12):1521–7.PubMedGoogle Scholar
  25. 25.
    Lehur PA, Stuto A, Fantoli M, Villani RD, Queralto M, Lazorthes F, et al. Outcomes of stapled transanal rectal resection vs. biofeedback for the treatment of outlet obstruction associated with rectal intussusception and rectocele: a multicenter, randomized, controlled trial. Dis Colon Rectum. 2008;51(11):1611–8.PubMedGoogle Scholar
  26. 26.
    Nieminen K, Hiltunen KM, Laitinen J, Oksala J, Heinonen PK. Transanal or vaginal approach to rectocele repair: a prospective, randomized pilot study. Dis Colon Rectum. 2004;47(10):1636–42.PubMedGoogle Scholar
  27. 27.
    Jorge JM, Yang YK, Wexner SD. Incidence and clinical significance of sigmoidoceles as determined by a new classification system. Dis Colon Rectum. 1994;37(11):1112–7.PubMedGoogle Scholar
  28. 28.
    Fenner DE. Diagnosis and assessment of sigmoidoceles. Am J Obstet Gynecol. 1996;175(6):1438–41. discussion 1441–2.PubMedGoogle Scholar
  29. 29.
    Lubiprostone (amitiza) for chronic constipation. Med Lett Drugs Ther. 2006;48(1236):47–8.Google Scholar
  30. 30.
    Lubiprostone (Amitiza) for irritable bowel syndrome with constipation. Med Lett Drugs Ther. 2008;50(1290):53–4.Google Scholar
  31. 31.
    Bassotti G, Gaburri M, Imbimbo BP, Rossi L, Farroni F, Pelli MA, et al. Colonic mass movements in idiopathic chronic constipation. Gut. 1988;29(9):1173–9.PubMedPubMedCentralGoogle Scholar
  32. 32.
    MacDonald A, Baxter JN, Finlay IG. Idiopathic slow-transit constipation. Br J Surg. 1993;80(9):1107–11.PubMedGoogle Scholar
  33. 33.
    Classic articles in colonic and rectal surgery. Sir William Arbuthnot Lane 1856–1943. The results of the operative treatment of chronic constipation. Dis Colon Rectum. 1985;28(10):750–7.Google Scholar
  34. 34.
    Redmond JM, Smith GW, Barofsky I, Ratych RE, Goldsborough DC, Schuster MM. Physiological tests to predict long-term outcome of total abdominal colectomy for intractable constipation. Am J Gastroenterol. 1995;90(5):748–53.PubMedGoogle Scholar
  35. 35.
    Glia A, Akerlund JE, Lindberg G. Outcome of colectomy for slow-transit constipation in relation to presence of small-bowel dysmotility. Dis Colon Rectum. 2004;47(1):96–102.PubMedGoogle Scholar
  36. 36.
    Bernini A, Madoff RD, Lowry AC, Spencer MP, Gemlo BT, Jensen LL, et al. Should patients with combined colonic inertia and nonrelaxing pelvic floor undergo subtotal colectomy? Dis Colon Rectum. 1998;41(11):1363–6.PubMedGoogle Scholar
  37. 37.
    Hassan I, Pemberton JH, Young-Fadok TM, You YN, Drelichman ER, Rath-Harvey D, et al. Ileorectal anastomosis for slow transit constipation: long-term functional and quality of life results. J Gastrointest Surg. 2006;10(10):1330–6. discussion 1336–7.PubMedGoogle Scholar
  38. 38.
    Heymen S, Wexner SD, Gulledge AD. MMPI assessment of patients with functional bowel disorders. Dis Colon Rectum. 1993;36(6):593–6.PubMedGoogle Scholar
  39. 39.
    Sarli L, Iusco D, Donadei E, Costi R, Sgobba G, Violi V, et al. The rationale for cecorectal anastomosis for slow transit constipation. Acta Biomed. 2003;74 Suppl 2:74–9.PubMedGoogle Scholar
  40. 40.
    Feng Y, Jianjiang L. Functional outcomes of two types of subtotal colectomy for slow-transit constipation: ileosigmoidal anastomosis and cecorectal anastomosis. Am J Surg. 2008;195(1):73–7.PubMedGoogle Scholar
  41. 41.
    Knowles CH, Scott M, Lunniss PJ. Outcome of colectomy for slow transit constipation. Ann Surg. 1999;230(5):627–38.PubMedPubMedCentralGoogle Scholar
  42. 42.
    Nyam DC, Pemberton JH, Ilstrup DM, Rath DM. Long-term results of surgery for chronic constipation. Dis Colon Rectum. 1997;40(3):273–9.PubMedGoogle Scholar
  43. 43.
    Pikarsky AJ, Efron J, Hamel CT, Weiss EG, Nogueras JJ, Wexner SD. Effect of age on the functional outcome of total abdominal colectomy for colonic inertia. Colorectal Dis. 2001;3(5):318–22.PubMedGoogle Scholar
  44. 44.
    Webster C, Dayton M. Results after colectomy for colonic inertia: a sixteen-year experience. Am J Surg. 2001;182(6):639–44.PubMedGoogle Scholar
  45. 45.
    Mollen RM, Kuijpers HC, Claassen AT. Colectomy for slow-transit constipation: preoperative functional evaluation is important but not a guarantee for a successful outcome. Dis Colon Rectum. 2001;44(4):577–80.PubMedGoogle Scholar
  46. 46.
    Verne GN, Hocking MP, Davis RH, Howard RJ, Sabetai MM, Mathias JR, et al. Long-term response to subtotal colectomy in colonic inertia. J Gastrointest Surg. 2002;6(5):738–44.PubMedGoogle Scholar
  47. 47.
    FitzHarris GP, Garcia-Aguilar J, Parker SC, Bullard KM, Madoff RD, Goldberg SM, et al. Quality of life after subtotal colectomy for slow-transit constipation: both quality and quantity count. Dis Colon Rectum. 2003;46(4):433–40.PubMedGoogle Scholar
  48. 48.
    Thaler K, Dinnewitzer A, Oberwalder M, Weiss EG, Nogueras JJ, Efron J, et al. Quality of life after colectomy for colonic inertia. Tech Coloproctol. 2005;9(2):133–7.PubMedGoogle Scholar
  49. 49.
    Zmora O, Colquhoun P, Katz J, Efron J, Weiss EG, Nogueras JJ, et al. Small bowel transit does not correlate with outcome of surgery in patients with colonic inertia. Surg Innov. 2005;12(3):215–8.PubMedGoogle Scholar
  50. 50.
    O’Brien S, Hyman N, Osler T, Rabinowitz T. Sexual abuse: a strong predictor of outcomes after colectomy for slow-transit constipation. Dis Colon Rectum. 2009;52(11):1844–7.PubMedGoogle Scholar
  51. 51.
    Lundin E, Karlbom U, Pahlman L, Graf W. Outcome of segmental colonic resection for slow-transit constipation. Br J Surg. 2002;89(10):1270–4.PubMedGoogle Scholar
  52. 52.
    Keighley MR, Grobler S, Bain I. An audit of restorative proctocolectomy. Gut. 1993;34(5):680–4.PubMedPubMedCentralGoogle Scholar
  53. 53.
    Kalbassi MR, Winter DC, Deasy JM. Quality-of-life assessment of patients after ileal pouch-anal anastomosis for slow-transit constipation with rectal inertia. Dis Colon Rectum. 2003;46(11):1508–12.PubMedGoogle Scholar
  54. 54.
    Scarpa M, Barollo M, Keighley MR. Ileostomy for constipation: long-term postoperative outcome. Colorectal Dis. 2005;7(3):224–7.PubMedGoogle Scholar
  55. 55.
    Kenefick NJ, Vaizey CJ, Cohen CR, Nicholls RJ, Kamm MA. Double-blind placebo-controlled crossover study of sacral nerve stimulation for idiopathic constipation. Br J Surg. 2002;89(12):1570–1.PubMedGoogle Scholar
  56. 56.
    Kenefick NJ. Sacral nerve neuromodulation for the treatment of lower bowel motility disorders. Ann R Coll Surg Engl. 2006;88(7):617–23.PubMedPubMedCentralGoogle Scholar
  57. 57.
    Malouf AJ, Wiesel PH, Nicholls T, Nicholls RJ, Kamm MA. Short-term effects of sacral nerve stimulation for idiopathic slow transit constipation. World J Surg. 2002;26(2):166–70.PubMedGoogle Scholar
  58. 58.
    Ganio E, Masin A, Ratto C, Altomare DF, Ripetti V, Clerico G, et al. Short-term sacral nerve stimulation for functional anorectal and urinary disturbances: results in 40 patients: evaluation of a new option for anorectal functional disorders. Dis Colon Rectum. 2001;44(9):1261–7.PubMedGoogle Scholar
  59. 59.
    Malone PS, Ransley PG, Kiely EM. Preliminary report: the antegrade continence enema. Lancet. 1990;336(8725):1217–8.PubMedGoogle Scholar
  60. 60.
    Williams NS, Hughes SF, Stuchfield B. Continent colonic conduit for rectal evacuation in severe constipation. Lancet. 1994;343(8909):1321–4.PubMedGoogle Scholar
  61. 61.
    Kiely EM, Ade-Ajayi N, Wheeler RA. Caecal flap conduit for antegrade continence enemas. Br J Surg. 1994;81(8):1215.PubMedGoogle Scholar
  62. 62.
    Sinha CK, Grewal A, Ward HC. Antegrade continence enema (ACE): current practice. Pediatr Surg Int. 2008;24(6):685–8.PubMedGoogle Scholar
  63. 63.
    Gerharz EW, Vik V, Webb G, Leaver R, Shah PJ, Woodhouse CR. The value of the MACE (Malone antegrade colonic enema) procedure in adult patients. J Am Coll Surg. 1997;185(6):544–7.PubMedGoogle Scholar
  64. 64.
    Lees NP, Hodson P, Hill J, Pearson RC, MacLennan I. Long-term results of the antegrade continent enema procedure for constipation in adults. Colorectal Dis. 2004;6(5):362–8.PubMedGoogle Scholar
  65. 65.
    Worsoe J, Christensen P, Krogh K, Buntzen S, Laurberg S. Long-term results of antegrade colonic enema in adult patients: assessment of functional results. Dis Colon Rectum. 2008;51(10):1523–8.PubMedGoogle Scholar
  66. 66.
    Teichman JM, Harris JM, Currie DM, Barber DB. Antegrade continence enema for adult neurogenic patients. Can J Urol. 1998;5(3):603–6.PubMedGoogle Scholar
  67. 67.
    Poirier M, Abcarian H, Nelson R. Malone antegrade continent enema: an alternative to resection in severe defecation disorders. Dis Colon Rectum. 2007;50(1):22–8.PubMedGoogle Scholar
  68. 68.
    Hirst GR, Arumugam PJ, Watkins AJ, Mackey P, Morgan AR, Carr ND, et al. Antegrade continence enema in the treatment of obstructed defaecation with or without faecal incontinence. Tech Coloproctol. 2005;9(3):217–21.PubMedGoogle Scholar
  69. 69.
    Longstreth GF, Wolde-Tsadik G. Irritable bowel-type symptoms in HMO examinees. Prevalence, demographics, and clinical correlates. Dig Dis Sci. 1993;38(9):1581–9.PubMedGoogle Scholar
  70. 70.
    Zuckerman MJ, Guerra LG, Drossman DA, Foland JA, Gregory GG. Comparison of bowel patterns in Hispanics and non-Hispanic whites. Dig Dis Sci. 1995;40(8):1763–9.PubMedGoogle Scholar
  71. 71.
    Taub E, Cuevas JL, Cook 3rd EW, Crowell M, Whitehead WE. Irritable bowel syndrome defined by factor analysis. Gender and race comparisons. Dig Dis Sci. 1995;40(12):2647–55.PubMedGoogle Scholar
  72. 72.
    Jain AP, Gupta OP, Jajoo UN, Sidhwa HK. Clinical profile of irritable bowel syndrome at a rural based teaching hospital in central India. J Assoc Physicians India. 1991;39(5):385–6.PubMedGoogle Scholar
  73. 73.
    Kay L, Jorgensen T, Jensen KH. The epidemiology of irritable bowel syndrome in a random population: prevalence, incidence, natural history and risk factors. J Intern Med. 1994;236(1):23–30.PubMedGoogle Scholar
  74. 74.
    Whitehead WE, Bosmajian L, Zonderman AB, Costa Jr PT, Schuster MM. Symptoms of psychologic distress associated with irritable bowel syndrome. Comparison of community and medical clinic samples. Gastroenterology. 1988;95(3):709–14.PubMedGoogle Scholar
  75. 75.
    Drossman DA, Camilleri M, Mayer EA, Whitehead WE. AGA technical review on irritable bowel syndrome. Gastroenterology. 2002;123(6):2108–31.PubMedGoogle Scholar
  76. 76.
    Bueno L, Fioramonti J, Ruckebusch Y, Frexinos J, Coulom P. Evaluation of colonic myoelectrical activity in health and functional disorders. Gut. 1980;21(6):480–5.PubMedPubMedCentralGoogle Scholar
  77. 77.
    Kellow JE, Phillips SF, Miller LJ, Zinsmeister AR. Dysmotility of the small intestine in irritable bowel syndrome. Gut. 1988;29(9):1236–43.PubMedPubMedCentralGoogle Scholar
  78. 78.
    Cann PA, Read NW, Brown C, Hobson N, Holdsworth CD. Irritable bowel syndrome: relationship of disorders in the transit of a single solid meal to symptom patterns. Gut. 1983;24(5):405–11.PubMedPubMedCentralGoogle Scholar
  79. 79.
    Lu CL, Chen CY, Chang FY, Lee SD. Characteristics of small bowel motility in patients with irritable bowel syndrome and normal humans: an Oriental study. Clin Sci. 1998;95(2):165–9.PubMedGoogle Scholar
  80. 80.
    Accarino AM, Azpiroz F, Malagelada JR. Attention and distraction: effects on gut perception. Gastroenterology. 1997;113(2):415–22.PubMedGoogle Scholar
  81. 81.
    Zighelboim J, Talley NJ, Phillips SF, Harmsen WS, Zinsmeister AR. Visceral perception in irritable bowel syndrome. Rectal and gastric responses to distension and serotonin type 3 antagonism. Dig Dis Sci. 1995;40(4):819–27.PubMedGoogle Scholar
  82. 82.
    Sun WM, Read NW, Prior A, Daly JA, Cheah SK, Grundy D. Sensory and motor responses to rectal distention vary according to rate and pattern of balloon inflation. Gastroenterology. 1990;99(4):1008–15.PubMedGoogle Scholar
  83. 83.
    Whitehead WE, Palsson OS. Is rectal pain sensitivity a biological marker for irritable bowel syndrome: psychological influences on pain perception. Gastroenterology. 1998;115(5):1263–71.PubMedGoogle Scholar
  84. 84.
    Munakata J, Naliboff B, Harraf F, Kodner A, Lembo T, Chang L, et al. Repetitive sigmoid stimulation induces rectal hyperalgesia in patients with irritable bowel syndrome. Gastroenterology. 1997;112(1):55–63.PubMedGoogle Scholar
  85. 85.
    Cook IJ, van Eeden A, Collins SM. Patients with irritable bowel syndrome have greater pain tolerance than normal subjects. Gastroenterology. 1987;93(4):727–33.PubMedGoogle Scholar
  86. 86.
    Silverman DH, Munakata JA, Ennes H, Mandelkern MA, Hoh CK, Mayer EA. Regional cerebral activity in normal and pathological perception of visceral pain. Gastroenterology. 1997;112(1):64–72.PubMedGoogle Scholar
  87. 87.
    Keogh E, Ellery D, Hunt C, Hannent I. Selective attentional bias for pain-related stimuli amongst pain fearful individuals. Pain. 2001;91(1–2):91–100.PubMedGoogle Scholar
  88. 88.
    Fukudo S, Nomura T, Hongo M. Impact of corticotropin-releasing hormone on gastrointestinal motility and adrenocorticotropic hormone in normal controls and patients with irritable bowel syndrome. Gut. 1998;42(6):845–9.PubMedPubMedCentralGoogle Scholar
  89. 89.
    Pimentel M, Chow EJ, Lin HC. Eradication of small intestinal bacterial overgrowth reduces symptoms of irritable bowel syndrome. Am J Gastroenterol. 2000;95(12):3503–6.PubMedGoogle Scholar
  90. 90.
    Pimentel M, Chow EJ, Lin HC. Normalization of lactulose breath testing correlates with symptom improvement in ­irritable bowel syndrome. A double-blind, randomized, ­placebo-controlled study. Am J Gastroenterol. 2003;98(2):412–9.PubMedGoogle Scholar
  91. 91.
    Posserud I, Stotzer PO, Bjornsson ES, Abrahamsson H, ­Simren M. Small intestinal bacterial overgrowth in patients with irritable bowel syndrome. Gut. 2007;56(6):802–8.PubMedGoogle Scholar
  92. 92.
    Chadwick VS, Chen W, Shu D, Paulus B, Bethwaite P, Tie A, et al. Activation of the mucosal immune system in irritable bowel syndrome. Gastroenterology. 2002;122(7):1778–83.PubMedGoogle Scholar
  93. 93.
    Barbara G, Stanghellini V, De Giorgio R, Cremon C, Cottrell GS, Santini D, et al. Activated mast cells in proximity to colonic nerves correlate with abdominal pain in irritable bowel syndrome. Gastroenterology. 2004;126(3):693–702.PubMedGoogle Scholar
  94. 94.
    Drossman DA, McKee DC, Sandler RS, Mitchell CM, Cramer EM, Lowman BC, et al. Psychosocial factors in the irritable bowel syndrome. A multivariate study of patients and nonpatients with irritable bowel syndrome. Gastroenterology. 1988;95(3):701–8.PubMedGoogle Scholar
  95. 95.
    Drossman DA, Leserman J, Nachman G, Li ZM, Gluck H, Toomey TC, et al. Sexual and physical abuse in women with functional or organic gastrointestinal disorders. Ann Intern Med. 1990;113(11):828–33.PubMedGoogle Scholar
  96. 96.
    Creed F, Craig T, Farmer R. Functional abdominal pain, psychiatric illness, and life events. Gut. 1988;29(2):235–42.PubMedPubMedCentralGoogle Scholar
  97. 97.
    Levy RL, Jones KR, Whitehead WE, Feld SI, Talley NJ, Corey LA. Irritable bowel syndrome in twins: heredity and social learning both contribute to etiology. Gastroenterology. 2001;121(4):799–804.PubMedGoogle Scholar
  98. 98.
    Layer P, Keller J, Mueller-Lissner S, Ruegg P, Loeffler H. Tegaserod: long-term treatment for irritable bowel syndrome patients with constipation in primary care. Digestion. 2005;71(4):238–44.PubMedGoogle Scholar
  99. 99.
    Pimentel M. Review of rifaximin as treatment for SIBO and IBS. Expert Opin Investig Drugs. 2009;18(3):349–58.PubMedGoogle Scholar
  100. 100.
    Yang J, Lee HR, Low K, Chatterjee S, Pimentel M. Rifaximin versus other antibiotics in the primary treatment and retreatment of bacterial overgrowth in IBS. Dig Dis Sci. 2008;53(1):169–74.PubMedGoogle Scholar
  101. 101.
    Wilhelm SM, Brubaker CM, Varcak EA, Kale-Pradhan PB. Effectiveness of probiotics in the treatment of irritable bowel syndrome. Pharmacotherapy. 2008;28(4):496–505.PubMedGoogle Scholar
  102. 102.
    Corazziari E. Role of opioid ligands in the irritable bowel syndrome. Can J Gastroenterol. 1999;13(Suppl A):71A–5.PubMedGoogle Scholar
  103. 103.
    Ternent CA, Bastawrous AL, Morin NA, Standards Practice Task Force of the American Society of Colon and Rectal Surgeons, et al. Practice parameters for the evaluation and management of constipation. Dis Colon Rectum. 2007;50:2013–22.PubMedGoogle Scholar

Copyright information

© ASCRS (American Society of Colon and Rectal Surgeons) 2011

Authors and Affiliations

  • Madhulika G. Varma
    • 1
  • Brooke H. Gurland
    • 2
  1. 1.Department of SurgeryUniversity of California, San FranciscoSan FranciscoUSA
  2. 2.Department of Colorectal SurgeryCleveland Clinic FoundationClevelandUSA

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