Management of constipation: A narrative review of evolving strategies and methodological challenges

Figure 3 Workflow in diagnosing and treating functional constipation in adults. Proposed clinical algorithm for the evaluation and management of chronic functional constipation, beginning with exclusion of secondary and organic causes, followed by empiric therapy and escalation based on treatment response. Physiologic testing, including colonic transit studies and anorectal function testing, is incorporated to distinguish normal-transit constipation, slow-transit constipation, and defecatory disorders, thereby guiding targeted therapy. CTT: Colonic transit time; FED: Fecal evacuation disorder; IBS-C: Irritable bowel syndrome with constipation.