Safer Care Victoria’s Best Care resources support patients and healthcare providers to have conversations and make decisions together about the most appropriate pathways for care.
This resource, developed for clinicians, details a specific elective surgery procedure that should now only be done for specific indications. Evidence-based recommendations that detail ‘best care’ pathways should be discussed with your patient to determine the most appropriate pathway of care.
Advice
A diagnostic colonoscopy is not indicated for long-standing (> 12 months) constipation with no critical factor (positive faecal test, anaemia, rectal bleeding, age ≥ 60 years) or other symptoms (altered bowel habit for at least 6 weeks and no more than 12 months, diarrhoea, unexplained abdominal pain or weight loss).
When is the procedure indicated?
For a person under 60 years of age who has long-standing constipation, a diagnostic colonoscopy should only be considered when a family history of colon cancer indicates the need for a screening colonoscopy or any alarm features as described in the National Health Medical Research Council-endorsed clinical guidelines are present that indicate the need for a diagnostic colonoscopy.
There are some patients who ignore new onset constipation for longer than 12 months and these are exceptions who would require a diagnostic constipation on the grounds of “change in bowel habit”.
Best care recommendations
A diagnostic colonoscopy for long-standing constipation is likely to have minimal yield.
Undertaking a full patient history and physical examination, including a rectal examination, is recommended. If no critical factors or other symptoms are identified, conservative management is recommended.
Conservative management should include elements of patient education, behaviour modification, dietary changes, bulk-forming laxatives and non-bulk-forming laxatives and enemas.
If the patient exhibits no improvement through conservative management, imaging studies are indicated. At this stage, a diagnostic colonoscopy should be considered as part of management.
Evidence
Cancer Council Australia Colorectal Cancer Guidelines Working Party. Clinical practice guidelines for the prevention, early detection and management of colorectal cancer [Internet]. Sydney (NSW): Cancer Council Australia; 2017 [cited 2020 Jun 13].
Department of Health and Human Services. Specialist clinics resources: The Victorian Endoscopy Categorisation Decision Support Tool [Internet]. Melbourne (VIC): Department of Health and Human Services; 2017 [cited 2020 Nov 20].
Gupta M, Holub J, Knigge K, Eisen G. Constipation is not associated with an increased risk of rate of findings on colonoscopy: results from a national endoscopy consortium. Endoscopy. 2010 Mar;42(03):208-12.
Longstreth GF, Thompson WG, Chey WD, Houghton LA, Mearin F, Spiller RC. Functional bowel disorders. Gastroenterology. 2006 Apr 1;130(5):1480-91.
Power AM, Talley NJ, Ford AC. Association between constipation and colorectal cancer: systematic review and meta-analysis of observational studies. American Journal of Gastroenterology. 2013 Jun 1;108(6):894-903.