Presenter: Sabrina Kimball, ND, LAc, EAMP

Original Date: October 20, 2019

Outlet dysfunction constipation is commonly overlooked cause of chronic constipation. This group of conditions is often a consequence of poor coordination of colonic, abdominal, pelvic and rectal musculature resulting in ineffective or incomplete expulsion of stool during defecation. This can be caused by weak colonic contractions, rectal hyposensitivity, rectal outlet obstruction, poor lower abdominal muscle recruitment, increased ano-rectal muscle tone or anismus. It is estimated that about 50% of those with outlet dysfunction constipation also suffer from slow transit constipation. Outlet dysfunction constipation should be evaluated first in-office with a detailed history and physical examination. Further evaluation by a pelvic floor physical therapist or GI motility specialist is often warranted. Dr. Kimball discusses when to refer and common treatment approaches performed by specialists.

Treatment of outlet dysfunction constipation requires a coordinated and personalized approach to treatment to achieve resolution. As part of this presentation, Dr. Kimball reviews the application of behavioral modifications, dietary modifications, physical therapy, nutritional supplements, pharmaceuticals and biofeedback therapy to address outlet dysfunction constipation disorders. Also discussed is the use of osmotic laxatives, stool softeners, enemas, colonic secretogogues: linclotide and lubiprostone, muscle relaxants: tizanidine and cyclobenzaprine, and botulinum toxin injection.

1.0 General CEUs approved by OBNM