Irritable bowel syndrome and chronic constipation: Fact and fiction

Table 1 Secondary causes of constipation

Drugs	Opiates, anticholinergics, antidepressants, anticonvulsants, calcium channel blockers
Endocrine and metabolic diseases	Hypothyroidism, hypercalcemia, diabetes, porphyria
Neurological diseases	Parkinson's disease, multiple sclerosis, spinal cord injury, autonomic neuropathy
Psychiatric disorders	Depression, eating disorders, obsessive disorders
Gastrointestinal diseases	Bowel obstruction, agangliosi, myopathies, neuropathies, megacolon/megarectum, anal atresia, anal stenosis

Table 2 Rome III diagnostic criteria for functional defecation disorders

Criteria fulfilled for the last 3 mo with symptom onset at least 6 mo prior to diagnosis

The patient must satisfy diagnostic criteria for functional constipation

During repeated attempts to defecate must have at least two of the following:

Evidence of impaired evacuation, based on balloon expulsion test or imaging

Inappropriate contraction of the pelvicfloor muscles (e.g., anal sphincter or puborectalis) or less than 20% relaxation of basal resting sphincter pressure by manometry, imaging, or EMG

Inadequate propulsive forces assessed by manometry or imaging