Constipation affects nearly everyone at some stage in their life. However, about 1 in 100 people in the UK suffer chronic symptoms that fail to respond to simple treatments including exercise, drinking more fluid, better diet and laxatives.
We call this ‘chronic constipation’, and it can be very difficult to treat, even by experts. We can give stronger laxatives and newer drugs and provide nurse-led bowel retraining classes, bowel irrigation and even surgery. However, we do not know what tests we should do first and what treatments we should then use. The Chronic Constipation Treatment Pathway (CapaCiTY) programme enrolled 275 participants to three trials:
CapaCiTY trial 1 – how good are different types of specialist nurse-led bowel retraining (182 participants)?
CapaCiTY trial 2 – what type of bowel irrigation via the anus should we use (65 participants)?
CapaCiTY trial 3 – how good is a type of surgical operation called laparoscopic ventral mesh rectopexy for internal bowel prolapse (28 participants)?
Unfortunately, the studies did not recruit enough participants to tell us for sure which test or treatment is best; however, we were able to draw some useful conclusions by combining symptom and quality-of-life outcomes, costs of treatment and participant interview responses about their experience:
All new treatments studied helped most participants.
Simple nurse-led retraining programmes were at least as good as more costly, complex ones.
Expensive tests did not help at an early stage.
Participants prefer using higher-volume bowel irrigation than lower-volume bowel irrigation and it has better results.
Despite worries about mesh, laparoscopic ventral mesh rectopexy seems safe in the short term and leads to a big drop in symptoms early after surgery. This was in very carefully chosen participants.
The programme helped to ensure that we all use the same tests and nurse-led therapies. We also published the most detailed reviews so far, to our knowledge, of different types of surgery for chronic constipation.
