ASGE Annual GI Advanced Practice Provider Course (On-demand) (Day Two) | March 2026-Constipation and Pelvic Floor Disorders: Diagnostic and Imaging Approaches

Video Transcription

Video Summary

The talk reviews evaluation and management of chronic constipation, emphasizing pelvic floor disorders. A polling question highlights that hyperthyroidism causes diarrhea rather than constipation, unlike Parkinson’s disease, anticholinergics, or calcium channel blockers. Constipation is defined by infrequent stools (<3/week), hard stools, straining, and incomplete evacuation, with Rome IV criteria used to distinguish functional constipation from IBS-C (IBS involves pain). Constipation is common (12–20%), especially in women, older adults, and neurologic patients, and causes major quality-of-life and healthcare burden.<br /><br />Constipation is classified as primary (normal transit, slow transit, defecatory dysfunction/pelvic floor dysfunction) or secondary (medications, metabolic, neurologic, structural causes). History should clarify baseline vs recent change and use the Bristol Stool Scale to align terminology. Workup includes rectal exam, CBC, TSH, calcium, glucose, and imaging (abdominal X-ray; transit studies; anorectal manometry; defecography/MRI). Management starts with optimizing OTC agents (PEG/Miralax, senna) and escalates to prescriptions (linaclotide, plecanatide, prucalopride, lubiprostone), mindful of insurance. For dyssynergic defecation, anorectal manometry guides diagnosis; pelvic floor therapy and biofeedback are key, teaching relaxation and proper defecation mechanics.

Asset Subtitle

Jill Olmstead, DNP, ANP-BC, FAANP

Keywords

chronic constipation

pelvic floor dysfunction

dyssynergic defecation

Rome IV criteria

anorectal manometry

biofeedback therapy