Medical management is first step in treating constipation: thorough history, exam are important for each case, and every complaint of bleeding and obstruction should be investigated.(Gynecology)

FORT LAUDERDALE, FLA. -- Constipation is a common complaint, and the causes for this condition are varied, Dana R. Sands, M.D., said during a symposium on pelvic floor disorders that was sponsored by the Cleveland Clinic Florida.

In a survey of more than 10,000 people, nearly 14% reported difficulty with evacuation, including infrequent defecation, incomplete defecation, and blockage of bowel movement.

"A surprising 12% said they need to use digital maneuvers in order to defecate--that's a high number," said Dr. Sands of the Cleveland Clinic Florida, Weston.

Among the causes of constipation are paradoxical puborectalis contraction, rectocele, and pelvic floor failure, including rectal prolapse and rectoanal intussusception, but sometimes the cause can be as simple as a lack of fiber and water in the diet, she said.

Those who haven't tried fiber supplements and increased water intake will often find their constipation is "miraculously" cured simply by trying these two things, she noted during the meeting.

But a thorough history and physical examination are important in all patients, and every complaint of bleeding and obstruction should be investigated, she said. She also recommended that some form of endoscopic evaluation be performed in patients with such complaints.

"It's our job to make sure rectal bleeding really is from hemorrhoids, and that constipation really is constipation," and that obstructing cancer is not the cause in either case, Dr. Sands commented, adding that she performs colonoscopy on all patients reporting changes in bowel habits.