{"id":7844,"date":"2023-12-08T06:47:25","date_gmt":"2023-12-08T09:47:25","guid":{"rendered":"https:\/\/gastropedia.pub\/pt\/?p=7844"},"modified":"2025-03-03T18:20:03","modified_gmt":"2025-03-03T21:20:03","slug":"constipacao-intestinal-funcional-como-diferenciar-e-manejar","status":"publish","type":"post","link":"https:\/\/gastropedia.pub\/pt\/cirurgia\/constipacao-intestinal-funcional-como-diferenciar-e-manejar\/","title":{"rendered":"Constipa\u00e7\u00e3o intestinal funcional: como diferenciar e manejar?"},"content":{"rendered":"<div class=\"pdfprnt-buttons pdfprnt-buttons-post pdfprnt-top-right\"><a href=\"https:\/\/gastropedia.pub\/pt\/wp-json\/wp\/v2\/posts\/7844?print=pdf\" class=\"pdfprnt-button pdfprnt-button-pdf\" target=\"_blank\" ><img decoding=\"async\" src=\"https:\/\/gastropedia.pub\/pt\/wp-content\/plugins\/pdf-print\/images\/pdf.png\" alt=\"image_pdf\" title=\"Ver PDF\" \/><\/a><a href=\"https:\/\/gastropedia.pub\/pt\/wp-json\/wp\/v2\/posts\/7844?print=print\" class=\"pdfprnt-button pdfprnt-button-print\" target=\"_blank\" ><img decoding=\"async\" src=\"https:\/\/gastropedia.pub\/pt\/wp-content\/plugins\/pdf-print\/images\/print.png\" alt=\"image_print\" title=\"Conte\u00fado de impress\u00e3o\" \/><\/a><\/div>\r\n<p>&nbsp;<\/p>\r\n\r\n\r\n\r\n<h2 id=\"h-resumo\" class=\"wp-block-heading\"><strong>Resumo:<\/strong><\/h2>\r\n\r\n\r\n\r\n<p>A Constipa\u00e7\u00e3o Intestinal Funcional ou Constipa\u00e7\u00e3o Intestinal Cr\u00f4nica (CIC) \u00e9 uma desordem do trato gastrointestinal (TGI) baixo que pode estar associada a sintomas como evacua\u00e7\u00e3o infrequente e incompleta, afetando entre 15-20% dos adultos e contando com um grupo de sintomas que v\u00e3o al\u00e9m do n\u00famero de evacua\u00e7\u00f5es por semana. Suas causas s\u00e3o divididas em prim\u00e1ria e secund\u00e1ria. A investiga\u00e7\u00e3o diagn\u00f3stica inicia com uma anamnese direcionada ao h\u00e1bito alimentar e intestinal, uso de medicamentos e sintomas de tr\u00e2nsito lento ou obstru\u00e7\u00e3o de sa\u00edda. O manejo cl\u00ednico deve ser iniciado antes mesmo da utiliza\u00e7\u00e3o da proped\u00eautica armada, que tem maior utilidade quando se pensa em interven\u00e7\u00f5es terap\u00eauticas dirigidas, como a fisioterapia ou mesmo a cirurgia. Neste cap\u00edtulo abordaremos a CIC desde sua etiologia at\u00e9 o manejo apropriado. Se quiser conferir nossa <strong>live <\/strong>discutindo esse assunto <strong><a href=\"https:\/\/gastropedia.com.br\/live\/constipacao-funcional-como-diferenciar-e-manejar\/\">clique aqui<\/a><\/strong>.<\/p>\r\n\r\n\r\n\r\n<h2 id=\"h-introducao\" class=\"wp-block-heading\"><strong>Introdu\u00e7\u00e3o<\/strong><\/h2>\r\n\r\n\r\n\r\n<p>A Constipa\u00e7\u00e3o Intestinal Cr\u00f4nica (CIC) \u00e9 uma desordem do trato gastrointestinal (TGI) baixo do eixo intestino-c\u00e9rebro e pode estar associada a sintomas como evacua\u00e7\u00e3o infrequente e incompleta, na aus\u00eancia de anormalidades estruturais.<\/p>\r\n\r\n\r\n\r\n<p>A CIC \u00e9 um problema de alta preval\u00eancia, afetando entre 15-20% dos adultos, dentre os quais 33% possuem idade maior que 60 anos, com predomin\u00e2ncia no sexo feminino.<\/p>\r\n\r\n\r\n\r\n<p class=\"has-very-light-gray-to-cyan-bluish-gray-gradient-background has-background\">A defini\u00e7\u00e3o de CIC envolve n\u00e3o apenas a redu\u00e7\u00e3o do n\u00famero de evacua\u00e7\u00f5es por semana, mas um conjunto de sintomas como esfor\u00e7o evacuat\u00f3rio, sensa\u00e7\u00e3o de evacua\u00e7\u00e3o incompleta, incapacidade de evacuar, uso de manobras digitais para eliminar as fezes, fezes endurecidas ou \u201c<em>bloating\u201d<\/em> e distens\u00e3o abdominal.<\/p>\r\n\r\n\r\n\r\n<h2 id=\"h-etiologia\" class=\"wp-block-heading\"><strong>Etiologia<\/strong><\/h2>\r\n\r\n\r\n\r\n<p>Causas de CIC podem ser d\u00edvidas nas seguintes categorias:<\/p>\r\n\r\n\r\n\r\n<h3 id=\"h-primaria-ou-idiopatica\" class=\"wp-block-heading\"><strong>Prim\u00e1ria ou Idiop\u00e1tica:<\/strong><\/h3>\r\n\r\n\r\n\r\n<p>Pacientes com esta condi\u00e7\u00e3o geralmente n\u00e3o possuem uma causa identificada na hist\u00f3ria e no exame f\u00edsico. Geralmente diagnosticada ap\u00f3s exclus\u00e3o de causas org\u00e2nicas, podendo ser classificadas da seguinte forma:<\/p>\r\n\r\n\r\n\r\n<ul class=\"wp-block-list\">\r\n<li><strong>Tempo de Tr\u00e2nsito Normal: a<\/strong>pesar do tr\u00e2nsito do bolo fecal pelo c\u00f3lon ser normal, pacientes apresentam dificuldades de evacuar. Corresponde a cerca de 60-65% dos casos.<\/li>\r\n\r\n\r\n\r\n<li><strong>Disfun\u00e7\u00e3o do Assoalho P\u00e9lvico\/ Obstru\u00e7\u00e3o de Sa\u00edda<\/strong> <strong>(ODS): <\/strong>ocorre por preju\u00edzo na musculatura do assoalho p\u00e9lvico e pacientes frequentemente relatam sensa\u00e7\u00e3o de evacua\u00e7\u00e3o incompleta, esfor\u00e7o evacuat\u00f3rio prolongado ou excessivo, uso de manobras\/press\u00e3o perineal durante evacua\u00e7\u00e3o. Ocorre em aproximadamente 20-25% dos portadores de CIC.<\/li>\r\n\r\n\r\n\r\n<li><strong>Tempo de Tr\u00e2nsito Lento \/ In\u00e9rcia C\u00f3lica (IC):<\/strong> caracterizado por movimentos intestinais infrequentes, pouca urg\u00eancia fecal ou esfor\u00e7o evacuat\u00f3rio. Corresponde a cerca de 5% dos casos<\/li>\r\n\r\n\r\n\r\n<li><strong>Mistas: <\/strong>IC associada a ODS, sendo observada em 2-3% dos pacientes portadores de CIC<\/li>\r\n<\/ul>\r\n\r\n\r\n\r\n<h3 id=\"h-causas-secundarias\" class=\"wp-block-heading\"><strong>Causas Secund\u00e1rias:<\/strong><\/h3>\r\n\r\n\r\n\r\n<p>A avalia\u00e7\u00e3o cl\u00ednica deve buscar investigar causas intestinais e extraintestinais, anormalidades metab\u00f3licas\/hormonais e uso de medicamentos (quadro 1).<\/p>\r\n\r\n\r\n\r\n<figure class=\"wp-block-table\">\r\n<div class=\"pcrstb-wrap\"><table>\r\n<tbody>\r\n<tr>\r\n<td><strong>Intestinais<\/strong><br \/>Tumores obstrutivos, estenose anal, atrasia anal, fissura anal, \u00e2nus imperfurado, estenoses inflamat\u00f3rias ou p\u00f3s-operat\u00f3rias, volvo, endometriose<\/td>\r\n<\/tr>\r\n<tr>\r\n<td><strong>Causas Neurol\u00f3gicas<\/strong><br \/>Doen\u00e7a de Hirchsprung, pseudo-obstru\u00e7\u00e3o intestinal, displasia neuronal, les\u00f5es medulares, espinha b\u00edfida, acidente vascular encef\u00e1lico, doen\u00e7a de Parkinson, Esclerose Multipla, doen\u00e7a de Chagas, disautonomia familiar<\/td>\r\n<\/tr>\r\n<tr>\r\n<td><strong>Medicamentos<\/strong><br \/>Anticolin\u00e9rgicos, narc\u00f3ticos, antidepressivos, sulfato ferroso, bloqueadores dos canais de c\u00e1lcio, anti-inflamat\u00f3rios n\u00e3o esteroides (AINES), drogas psicotr\u00f3picas, intoxica\u00e7\u00e3o por vitamina D<\/td>\r\n<\/tr>\r\n<tr>\r\n<td><strong>Causas Metab\u00f3licas e End\u00f3crinas<\/strong><br \/>Hipocalemia, hipercalcemia, hipotiroidismo, diabetes mellitus (DM) e diabetes insipidus<\/td>\r\n<\/tr>\r\n<tr>\r\n<td><strong>Miscel\u00e2nea<\/strong><br \/>Doen\u00e7a cel\u00edaca, alergia \u00e0 prote\u00edna do leite, Fibrose C\u00edstica, Doen\u00e7a inflamat\u00f3ria intestinal (DII) e esclerodermia, S\u00edndrome de Down, Gastrosquise, s\u00edndrome de Prune Belly.<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table><\/div>\r\n<figcaption class=\"wp-element-caption\"><strong>Quadro 1-<\/strong> Causas secund\u00e1rias de constipa\u00e7\u00e3o<\/figcaption>\r\n<\/figure>\r\n\r\n\r\n\r\n<h2 id=\"h-avaliacao-clinica\" class=\"wp-block-heading\"><strong>Avalia\u00e7\u00e3o Cl\u00ednica<\/strong><\/h2>\r\n\r\n\r\n\r\n<p>A investiga\u00e7\u00e3o da Constipa\u00e7\u00e3o Intestinal Cr\u00f4nica inicia-se com uma avalia\u00e7\u00e3o detalhada do h\u00e1bito intestinal, incluindo ingest\u00e3o de fibras e l\u00edquidos, hist\u00f3ria familiar de doen\u00e7as gastrointestinais, neurol\u00f3gicas e sist\u00eamicas e exame f\u00edsico completo, n\u00e3o devendo ser menosprezado o exame proctol\u00f3gico, particularmente a for\u00e7a de propuls\u00e3o retal e o relaxamento ou n\u00e3o do m\u00fasculo puborretal (Figura 1).<\/p>\r\n\r\n\r\n\r\n<p>&nbsp;<\/p>\r\n\r\n\r\n\r\n<figure class=\"wp-block-image size-large\"><a href=\"https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2024\/01\/Design-sem-nome.png\" data-rel=\"penci-gallery-image-content\" ><img decoding=\"async\" class=\"wp-image-8034\" src=\"https:\/\/gastropedia.com.br\/wp-content\/uploads\/2023\/12\/Design-sem-nome-1024x555.png\" alt=\"\" \/><\/a>\r\n<figcaption class=\"wp-element-caption\"><strong>Figura 1:<\/strong> A\u00e7\u00e3o do m\u00fasculo puborretal na contra\u00e7\u00e3o paradoxal \u00e0 esquerda, dificultando a evacua\u00e7\u00e3o e relaxando normalmente \u00e0 direita.<\/figcaption>\r\n<\/figure>\r\n\r\n\r\n\r\n<p>Tamb\u00e9m \u00e9 importante na anamnese interrogar poss\u00edveis causas secund\u00e1rias de constipa\u00e7\u00e3o (vide quadro 1) e descartar sinais de alarme para c\u00e2ncer colorretal, como perda de peso n\u00e3o intencional, sangramento via retal, hist\u00f3ria familiar de c\u00e2ncer ou doen\u00e7a inflamat\u00f3ria intestinal, pois se presentes, uma colonoscopia deve ser indicada.<\/p>\r\n\r\n\r\n\r\n<p>A utiliza\u00e7\u00e3o de <strong>crit\u00e9rios objetivos<\/strong> para o diagn\u00f3stico de CIC \u00e9 fundamental n\u00e3o s\u00f3 com esse objetivo, mas tamb\u00e9m para o seguimento e reavalia\u00e7\u00e3o do tratamento efetuado.<\/p>\r\n\r\n\r\n\r\n<p><strong>Dentre eles citam-se:<\/strong><\/p>\r\n\r\n\r\n\r\n<p><strong>&#8211; Crit\u00e9rios de Roma IV<\/strong>: sintomas presentes nos \u00faltimos tr\u00eas meses (n\u00e3o necessariamente consecutivos) e por um m\u00ednimo de seis meses (quadro 2).<\/p>\r\n\r\n\r\n\r\n<p><strong>&#8211; Escala da consist\u00eancia das fezes de Bristol<\/strong> (Figura 2)<\/p>\r\n\r\n\r\n\r\n<figure class=\"wp-block-image size-full\"><a href=\"https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2024\/01\/Design-sem-nome-1.png\" data-rel=\"penci-gallery-image-content\" ><img decoding=\"async\" class=\"wp-image-8036\" src=\"https:\/\/gastropedia.com.br\/wp-content\/uploads\/2023\/12\/Design-sem-nome-1.png\" alt=\"\" \/><\/a>\r\n<figcaption class=\"wp-element-caption\"><br \/><strong>Figura 2:<\/strong> escala de consist\u00eancia das fezes<\/figcaption>\r\n<\/figure>\r\n\r\n\r\n\r\n<p>&nbsp;<\/p>\r\n\r\n\r\n\r\n<p><strong>&#8211; Crit\u00e9rios de gravidade da CIC<\/strong>: <em>Constipation Score System Cleveland Clinic Florida<\/em>&#8211; crit\u00e9rios de Agachan, que conta com 8 quest\u00f5es referentes \u00e0 h\u00e1bito intestinal e dificuldade evacuat\u00f3ria e a frequ\u00eancia de ocorr\u00eancia, variando de 0 a 30 pontos.<\/p>\r\n\r\n\r\n\r\n<p>&#8211; Avalia\u00e7\u00e3o da <strong>qualidade de vida<\/strong> a partir de <strong>question\u00e1rios<\/strong> espec\u00edficos.<\/p>\r\n\r\n\r\n\r\n<figure class=\"wp-block-table\">\r\n<div class=\"pcrstb-wrap\"><table>\r\n<tbody>\r\n<tr>\r\n<td><strong>Constipa\u00e7\u00e3o Funcional<\/strong><\/td>\r\n<\/tr>\r\n<tr>\r\n<td><strong>1.<\/strong> Deve incluir 2 ou mais dos seguintes sintomas, presentes em &gt;25% das defeca\u00e7\u00f5es:<br \/><strong>a.<\/strong> Esfor\u00e7o<br \/><strong>b.<\/strong> Fezes endurecidas ou grumosas (Bristol 1-2)<br \/><strong>c.<\/strong> Sensa\u00e7\u00e3o de evacua\u00e7\u00e3o incompleta<br \/><strong>d. <\/strong>Sensa\u00e7\u00e3o de bloqueio retal\/obstru\u00e7\u00e3o<br \/><strong>e.<\/strong> Manobras manuais para facilitar (manobras digitais, suporte para o assoalho p\u00e9lvico)<br \/><strong>f. <\/strong>&lt;3 movimentos intestinais espont\u00e2neos por semana<br \/><strong>2<\/strong>. Fezes macias raramente presentes sem o uso de laxativos<br \/><strong>3<\/strong>. Crit\u00e9rios insuficientes para SII-c<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table><\/div>\r\n<figcaption class=\"wp-element-caption\"><strong>Quadro 2<\/strong> \u2013 Crit\u00e9rios de Roma IV para diagn\u00f3stico de CIC<\/figcaption>\r\n<\/figure>\r\n\r\n\r\n\r\n<h2 id=\"h-exames-complementares\" class=\"wp-block-heading\"><strong>Exames Complementares<\/strong><\/h2>\r\n\r\n\r\n\r\n<p>A investiga\u00e7\u00e3o armada deve ser realizada em casos de CIC refrat\u00e1rios ao tratamento medicamentoso, de acordo com o fluxograma sugerido na Figura 3.<\/p>\r\n\r\n\r\n\r\n<h3 id=\"h-1-manometria-anorretal\" class=\"wp-block-heading\"><strong>1. Manometria Anorretal<\/strong><\/h3>\r\n\r\n\r\n\r\n<p>Fornece informa\u00e7\u00f5es importantes como presen\u00e7a do reflexo inibit\u00f3rio retoanal (RIRA), t\u00f4nus dos esf\u00edncteres interno e externo do \u00e2nus, sinais sugestivos de contra\u00e7\u00e3o paradoxal ou n\u00e3o relaxamento adequado do m\u00fasculo puborretal, al\u00e9m da sensibilidade, capacidade e complac\u00eancia retais.<\/p>\r\n\r\n\r\n\r\n<p>Ao final do exame, preconiza-se a realiza\u00e7\u00e3o do teste de expuls\u00e3o do bal\u00e3o retal, em que solicita-se ao paciente a elimina\u00e7\u00e3o do mesmo, preferencialmente na posi\u00e7\u00e3o sentada no vaso sanit\u00e1rio, em uma de tr\u00eas tentativas com dura\u00e7\u00e3o de 60 segundos cada. Saiba mais sobre manometria anorretal <strong><a href=\"https:\/\/gastropedia.com.br\/cirurgia\/manometria-anorretal-conceitos-indicacoes-e-tecnica\/\">neste artigo<\/a><\/strong>.<\/p>\r\n\r\n\r\n\r\n<h3 id=\"h-2-exame-dinamico-da-evacuacao-videodefecografia-ressonancia-magnetica-dinamica-do-assoalho-pelvico-ou-ecodefecografia\" class=\"wp-block-heading\"><strong>2. Exame din\u00e2mico da evacua\u00e7\u00e3o: Videodefecografia, Resson\u00e2ncia Magn\u00e9tica din\u00e2mica do assoalho p\u00e9lvico ou Ecodefecografia<\/strong><\/h3>\r\n\r\n\r\n\r\n<p>Fornecem informa\u00e7\u00f5es \u00fateis sobre altera\u00e7\u00f5es anat\u00f4micas, como retocele, prolapso retal, enterocele, sigmoidocele, intussuscep\u00e7\u00e3o intrarretal, descenso perineal e dissinergia p\u00e9lvica (contra\u00e7\u00e3o paradoxal do m\u00fasculo puborretal e anismos).<\/p>\r\n\r\n\r\n\r\n<h3 id=\"h-3-tempo-de-transito-colico-ttc\" class=\"wp-block-heading\"><strong>3. Tempo de Tr\u00e2nsito C\u00f3lico (TTC)<\/strong><\/h3>\r\n\r\n\r\n\r\n<p>O TTC \u00e9 realizado com a ingest\u00e3o de uma c\u00e1psula contendo 24 marcadores radiopacos, com realiza\u00e7\u00e3o de Raios X de abdome e pelve no primeiro, terceiro e quinto dia ap\u00f3s a ingest\u00e3o. Considera-se normal a reten\u00e7\u00e3o de menos de 5 marcadores (20% do ingerido) ao final do 5\u00ba dia. Caso haja reten\u00e7\u00e3o de mais marcadores pode-se encontrar 2 padr\u00f5es distintos de altera\u00e7\u00e3o: in\u00e9rcia c\u00f3lica onde os marcadores ficam distribu\u00eddos aleatoriamente pelo c\u00f3lon e reto; e obstru\u00e7\u00e3o de sa\u00edda onde os marcadores concentram-se no retossigm\u00f3ide.<\/p>\r\n\r\n\r\n\r\n<p>&nbsp;<\/p>\r\n\r\n\r\n\r\n<figure class=\"wp-block-image size-large\"><a href=\"https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2024\/01\/Design-sem-nome-2.png\" data-rel=\"penci-gallery-image-content\" ><img decoding=\"async\" class=\"wp-image-8038\" src=\"https:\/\/gastropedia.com.br\/wp-content\/uploads\/2023\/12\/Design-sem-nome-2-526x1024.png\" alt=\"\" \/><\/a>\r\n<figcaption class=\"wp-element-caption\"><strong>Figura 3: <\/strong>Fluxograma de investiga\u00e7\u00e3o da constipa\u00e7\u00e3o intestinal cr\u00f4nica<\/figcaption>\r\n<\/figure>\r\n\r\n\r\n\r\n<h2 id=\"h-manejo-da-constipacao-intestinal-cronica\" class=\"wp-block-heading\"><strong>Manejo da Constipa\u00e7\u00e3o Intestinal Cr\u00f4nica<\/strong><\/h2>\r\n\r\n\r\n\r\n<p><strong>Tratamento N\u00e3o-Farmacol\u00f3gico<\/strong><\/p>\r\n\r\n\r\n\r\n<p>Mudan\u00e7as no estilo de vida auxiliam no controle intestinal, com aumento da atividade f\u00edsica, ingest\u00e3o de l\u00edquidos e carboidratos complexos ricos em fibras. Altera\u00e7\u00e3o na dieta costuma ser o manejo de primeira linha eficaz, sendo recomendado o aumento do consumo de fibras em aproximadamente 25-30g por dia.<\/p>\r\n\r\n\r\n\r\n<p><strong>Tratamento Farmacol\u00f3gico<\/strong><\/p>\r\n\r\n\r\n\r\n<p>Pacientes que n\u00e3o obtiveram resposta com mudan\u00e7as no estilo de vida devem seguir o tratamento com formadores de bolo fecal e, a seguir tem-se uma gama de laxantes, como os osm\u00f3ticos &#8211; polietilenoglicol (PEG) e lactulose, estimulantes \u2013 bisacodil, sena e picossulfato de s\u00f3dio, agentes pr\u00f3-cin\u00e9ticos como a prucaloprida, lubiprostona e linaclotida. Enemas ou suposit\u00f3rios devem ser utilizados em casos selecionados e por per\u00edodos curtos, assim como os medicamentos laxativos, principalmente os estimulantes.<\/p>\r\n\r\n\r\n\r\n<p><strong>Tratamento da disfun\u00e7\u00e3o do assoalho p\u00e9lvico (Biofeedback)<\/strong><\/p>\r\n\r\n\r\n\r\n<p>Pacientes com obstru\u00e7\u00e3o de sa\u00edda (anismus, contra\u00e7\u00e3o paradoxal do m\u00fasculo puborretal ou s\u00edndrome da espasticidade do assoalho p\u00e9lvico) devem ser encaminhados a fisioterapia p\u00e9lvica e biofeedback para reeduca\u00e7\u00e3o do relaxamento da musculatura p\u00e9lvica durante o ato evacuat\u00f3rio.<\/p>\r\n\r\n\r\n\r\n<h2 id=\"h-tratamento-cirurgico\" class=\"wp-block-heading\"><strong>Tratamento Cir\u00fargico<\/strong><\/h2>\r\n\r\n\r\n\r\n<p><strong>Constipa\u00e7\u00e3o por in\u00e9rcia c\u00f3lica<\/strong><\/p>\r\n\r\n\r\n\r\n<p>Pacientes refrat\u00e1rios ao tratamento conservador, ap\u00f3s exclus\u00e3o de obstru\u00e7\u00e3o de sa\u00edda, podem se beneficiar de uma colectomia total com anastomose ileorretal minimamente invasiva\u0007\u0003\b. Antes de indicar o tratamento cir\u00fargico, \u00e9 importante na investiga\u00e7\u00e3o descartar dismotilidade do TGI superior (gastroparesia e pseudo-obstru\u00e7\u00e3o intestinal), doen\u00e7as psiqui\u00e1tricas graves e doen\u00e7as neurol\u00f3gicas sist\u00eamicas como diabetes mellitus e esclerose sist\u00eamica\u0007\u0003\b.<\/p>\r\n\r\n\r\n\r\n<p><strong>Obstru\u00e7\u00e3o de Sa\u00edda<\/strong><\/p>\r\n\r\n\r\n\r\n<p>As principais indica\u00e7\u00f5es de cirurgia no tratamento da constipa\u00e7\u00e3o por obstru\u00e7\u00e3o de sa\u00edda s\u00e3o retoceles, enteroceles, sigmoidoceles e prolapsos, e a t\u00e9cnica cir\u00fargica utilizada deve ser individualizada, dentre as corre\u00e7\u00f5es transanal, transvaginal, transperineal ou abdominal minimamente invasiva\u0007\u0003\b.<\/p>\r\n<p>Conhe\u00e7a nosso curso <strong><a href=\"https:\/\/gastropedia.pub\/pt\/cursos\/gastroenterologia-do-consultorio\/\">Gastroenterologia do Consult\u00f3rio<\/a><\/strong> e saiba como lidar com as queixas mais comuns que encontramos no dia a dia<\/p>\r\n\r\n\r\n\r\n<h2 id=\"h-referencias\" class=\"wp-block-heading\"><strong>Refer\u00eancias<\/strong><\/h2>\r\n\r\n\r\n\r\n<ol class=\"wp-block-list\">\r\n<li>Agachan F, Chen T, Pfeifer J, Reissman P, Wexner SD. A constipation scoring system to simplify evaluation and management of constipated patients. Dis Colon Rectum. 1996; 39:681-5.<\/li>\r\n\r\n\r\n\r\n<li>Chang L, Chey WD, Imdad A, Almario CV, Bharucha AE, Diem S, et al. American Gastroenterological Association &#8211; American College of Gastroenterology clinical practice guideline: pharmacological management of chronic idiopathic constipation. The American Journal of Gastroenterology. 2023;118(6):936-54.<\/li>\r\n\r\n\r\n\r\n<li>Sobrado CW, Corr\u00eaa Neto IJF, Pinto RA, Sobrado LF, Nahas SC, Cecconello I. Diagnosis and treatment of constipation: a clinical update based on the Rome IV criteria. Journal of Coloproctology. 2018; 38:137-44.<\/li>\r\n\r\n\r\n\r\n<li>Costilla VC, Foxx-Orenstein AE. Constipation in adults: diagnosis and management. Current Treatment Options in Gastroenterology. 2014;12(3):310-21.<\/li>\r\n\r\n\r\n\r\n<li>Pannemans J, Masuy I, Tack J. Functional constipation: individualising assessment and treatment. Drugs. 2020;80(10):947-63.<\/li>\r\n\r\n\r\n\r\n<li>Soh JS, Lee HJ, Jung KW, Yoon IJ, Koo HS, Seo SY, et al. The diagnostic value of a digital rectal examination compared with high-resolution anorectal manometry in patients with chronic constipation and fecal incontinence. The American Journal of Gastroenterology. 2015;110(8):1197-204.<\/li>\r\n\r\n\r\n\r\n<li>Tantiphlachiva K, Rao P, Attaluri A, Rao SS. Digital rectal examination is a useful tool for identifying patients with dyssynergia. Clinical Gastroenterology and Hepatology: the official clinical practice journal of the American Gastroenterological Association. 2010;8(11):955-60<\/li>\r\n<\/ol>\r\n\r\n\r\n\r\n<h2 id=\"h-como-citar-este-artigo\" class=\"wp-block-heading\">Como citar este artigo<\/h2>\r\n\r\n\r\n\r\n<p class=\"has-very-light-gray-to-cyan-bluish-gray-gradient-background has-background\">Pinto RA, Correa Neto IJ, Lima AP, Marques CFS. Constipa\u00e7\u00e3o intestinal funcional: como diferenciar e manejar? Gastropedia 2023, vol 2. Dispon\u00edvel em: <a href=\"https:\/\/gastropedia.com.br\/?p=8033\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/gastropedia.com.br\/cirurgia\/colorretal\/constipacao-intestinal-funcional-como-diferenciar-e-manejar\/<\/a><\/p>\r\n","protected":false},"excerpt":{"rendered":"<p>&nbsp; Resumo: A Constipa\u00e7\u00e3o Intestinal Funcional ou Constipa\u00e7\u00e3o Intestinal Cr\u00f4nica (CIC) \u00e9 uma desordem do trato gastrointestinal (TGI) baixo que pode estar associada a sintomas como evacua\u00e7\u00e3o infrequente e incompleta,&hellip;<\/p>\n","protected":false},"author":5726,"featured_media":7845,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"no","_lmt_disable":"","footnotes":""},"categories":[24,26,397],"tags":[],"ano":[137],"tipo":[121],"volume":[44],"class_list":["post-7844","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-cirurgia","category-colorretal","category-traducao","ano-137","tipo-assuntos-gerais","volume-volume-ii"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.2 (Yoast SEO v27.3) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Constipa\u00e7\u00e3o intestinal funcional: como diferenciar e manejar? - Gastropedia<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" 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