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

Pdf Summary

This presentation reviews evaluation and management of chronic constipation with emphasis on pelvic floor (defecatory) disorders. Constipation is defined functionally by infrequent bowel movements (about ≤3/week), hard stools, straining, and incomplete evacuation, and diagnostically using Rome IV criteria to distinguish chronic idiopathic constipation from IBS with constipation. Constipation affects about 12–20% of adults and is more common in women, older adults, and those with neurologic disease; it significantly impacts quality of life, increases healthcare use, and is often linked to pelvic floor dysfunction.<br /><br />Constipation is classified as primary (normal transit, slow transit, and defecatory disorders/pelvic floor dysfunction) or secondary (medication-induced, metabolic, neurologic, or structural causes such as hypothyroidism, Parkinson’s disease, and diabetes). Stool form can be categorized with the Bristol Stool Scale (constipation typically types 1–2).<br /><br />The talk outlines Rome IV criteria for functional constipation and functional defecation disorders (FDD). FDD diagnosis requires constipation/IBS-C plus evidence of impaired evacuation on at least two of three tests: balloon expulsion, anorectal manometry/anal surface EMG, or imaging. Subtypes include inadequate defecatory propulsion and dyssynergic defecation (inappropriate pelvic floor/anal contraction despite adequate propulsive forces).<br /><br />Recommended evaluation includes abdominal and digital rectal exams (tone, paradoxical contraction, masses, rectocele), basic labs (CBC, TSH, calcium, glucose), and targeted testing: abdominal x-ray, colonic transit studies (radiopaque markers/Sitz markers, scintigraphy, wireless motility capsule), anorectal manometry and balloon expulsion, and imaging such as defecography/MRI defecography; colonoscopy or CT may be used when indicated.<br /><br />Management starts with fiber and laxatives (OTC and prescription). For dyssynergic defecation, treatment includes laxatives plus pelvic floor therapy/biofeedback to retrain coordinated defecation.

Asset Subtitle

Jill Olmstead, DNP, ANP-BC, FAANP

Keywords

chronic constipation

Rome IV criteria

IBS with constipation (IBS-C)

functional defecation disorders (FDD)

pelvic floor dysfunction

dyssynergic defecation

anorectal manometry

balloon expulsion test

colonic transit studies (Sitz markers)

biofeedback therapy