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
