Pescatori M, Perrotta G, De Nardi P. Functional disorders in patients with chronic constipation: Review of the literature and personal experience. World J Gastroenterol 2026; 32(19): 113841 [DOI: 10.3748/wjg.v32.i19.113841]
Corresponding Author of This Article
Mario Pescatori, MD, Professor, Department of Coloproctology, Parioli Clinic, Via Courmayeur, 24, Rome 00100, Italy. ucpclub@virgilio.it
Research Domain of This Article
Pathology
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Minireviews
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Pescatori M, Perrotta G, De Nardi P. Functional disorders in patients with chronic constipation: Review of the literature and personal experience. World J Gastroenterol 2026; 32(19): 113841 [DOI: 10.3748/wjg.v32.i19.113841]
World J Gastroenterol. May 21, 2026; 32(19): 113841 Published online May 21, 2026. doi: 10.3748/wjg.v32.i19.113841
Functional disorders in patients with chronic constipation: Review of the literature and personal experience
Mario Pescatori, Gerardo Perrotta, Paola De Nardi
Mario Pescatori, Department of Coloproctology, Parioli Clinic, Rome 00100, Italy
Gerardo Perrotta, Department of Colorectal Surgery, Vita-Salute San Raffaele University, Milan 20132, Italy
Paola De Nardi, Department of Colorectal Surgery, IRCCS San Raffaele Scientific Institute, Milan 20132, Italy
Author contributions: Pescatori M conceptualized and designed the study, drafted the original manuscript; Perrotta G and De Nardi P conducted the literature review and made critical revisions; all authors prepared the draft and approved the submitted version.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Corresponding author: Mario Pescatori, MD, Professor, Department of Coloproctology, Parioli Clinic, Via Courmayeur, 24, Rome 00100, Italy. ucpclub@virgilio.it
Received: September 8, 2025 Revised: January 8, 2026 Accepted: March 5, 2026 Published online: May 21, 2026 Processing time: 256 Days and 3.6 Hours
Abstract
Most patients with constipation do not require surgical treatment unless the cause of their symptoms is organic, such as entero-sigmoidocele or rectal intussusception. This review focuses on patients whose constipation is functional, such as slow-transit constipation or anismus. Selecting the appropriate treatment can be challenging in such cases, and surgery may worsen symptoms. This is because a relevant psychological component may be present, in which case psychiatric or psychological treatment may be more appropriate than surgery. The authors report their personal experience and review the literature with the aim of suggesting practical clinical guidelines. Obstructed defecation (OD) is examined in detail, considering both functional and organic etiologies. Apart from the frequent rectocele and rectal mucosal prolapse, which are usually easily diagnosed, OD often reflects additional functional disorders that are not easily detected. The most common are psychological distress, anismus, and rectal hyposensitivity. These conditions require accurate diagnosis and targeted treatment.
Core Tip: Obstructed defecation is frequently driven by functional disorders that are often overlooked, leading to inappropriate surgical treatment and poor outcomes. Using the iceberg model, this article emphasizes that anxiety, depression, anismus, rectal hyposensitivity, slow transit constipation, and pudendal neuropathy account for most hidden causes of obstructed defecation. Careful functional evaluation and multidisciplinary management allow surgery to be avoided in the majority of patients and significantly reduce treatment failure and complications. Surgery should be reserved for selected organic conditions, while functional disorders require targeted, non-surgical therapies to achieve durable symptom improvement.
