Die chronische Obstipation ist das häufigste gastrointestinale Symptom bei Diabetespatienten und geht häufig mit einer stark eingeschränkten Lebensqualität einher. Sie ist durch einen verzögerten Stuhltransport oder eine erschwerte Stuhlentleerung oder auch eine Kombination beider Formen gekennzeichnet. Die Behandlung sollte dem Grundprinzip einer Therapieeskalation von einfachen, u. a. diätetischen Maßnahmen über stuhlregulierende und abführende Substanzen bis hin zu operativen Möglichkeiten folgen.
Abstract
Diabetes patients often suffer from gastrointestinal disturbances, resulting from autonomic diabetic neuropathy in many cases. Chronic constipation (CC) is the most frequent gastrointestinal symptom in patients with diabetes. CC is characterised by slow transit constipation and/or outlet obstruction. A thorough past medical history, considering the Rome III criteria, is of key importance. Risk factors such as other metabolic disorders, psychiatric disorders as well as constipation-inducing drugs and life circumstances have to be identified. Protological consultation comprises, besides a general physical examination, simple functional tests as well as proctoscopy and rectoscopy. Additional imaging techniques, such as defecography, are available for further characterization of CC. Basic measures in CC treatment comprise an active lifestyle, a fibre-rich diet and sufficient hydration. In outlet obstruction disorders, in addition to biofeedback training, suppositories and enemas are used. In contrast, in slow transit constipation, bulk-forming, osmotic, and stimulant laxatives as well as prokinetic agents alone or in combination can be used. In light of the often tremendously decreased quality of life in patients with CC, surgical approaches should not be withhold to the affected patients. However, prior to surgical interventions, the patients should have received all conservative measures and the decision for surgery should be well-balanced. The present article aims at giving an overview of diagnosis and treatment of CC in patients with diabetes.
Schlüsselwörter
chronische Obstipation - Diabetes mellitus - Defäkation - Darmmotilität
Key words
chronic constipation - diabetes mellitus - defecation - gastrointestinal motility
