Slow Transit Constipation

Slow transit constipation is a rare condition that is almost exclusively encountered in middle-aged women. The pathophysiology and aetiology are poorly understood, but a multifactorial pathogenesis seems likely. In the course of the differential diagnosis, mechanical, drug-induced, degenerative, metabolic, endocrinological, neurological and psychiatric causes of constipation must be excluded by an interdisciplinary approach. Gastrointestinal physiological investigations are mandatory, including measurement of colonic transit. Furthermore, pangastrointestinal transit delay, pelvic floor dysfunction and irritable bowel syndrome should be excluded. The initial mode of treatment is strictly conservative. In cases of progression or persistence of symptoms, surgical therapy should be discussed. Subtotal colectomy with ileorectal anastomosis can be regarded as the standard operation for slow transit constipation. Postoperative complications include small bowel obstruction, incontinence and persistence or recurrence of constipation and/or abdominal pain. Using strict criteria for patient selection, overall success rates are reported in excess of 80%.