[Women with chronic constipation: clinical examination is more important than anorectal function testing].

Chronic constipation is a common disorder, particularly in women and the elderly. Physical examination of patients with constipation should include rectal examination and in women also vaginal examination. The patient is asked to relax, contract and bear down on the pelvic floor during inspection of the anal region as well as during the rectal examination. Patients can be considered to have a hypertonic pelvic floor when they have difficulty in relaxing or no relaxation at all during straining on three consecutive attempts. Physical examination reveals potentially treatable conditions such as a rectocele or pelvic floor hypertonia in 40% of women with chronic constipation. Anorectal manometry and anal endosonography provide little added value to physical examination in women with chronic constipation. Anorectal function testing should be reserved for selected cases.