Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.
World J Gastroenterol. May 21, 2026; 32(19): 113841
Published online May 21, 2026. doi: 10.3748/wjg.v32.i19.113841
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, 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
Revised: January 8, 2026
Accepted: March 5, 2026
Published online: May 21, 2026
Processing time: 256 Days and 3.6 Hours
Core Tip
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.