Constipation

Original Editor - User:Nicole Sandhu Top Contributors - Nicole Sandhu, Kim Jackson and Vidya Acharya

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Definition

Chronic constipation is infrequent bowel movements or difficult passage of stools that persists for several weeks or longer.

Clinically Relevant Anatomy

Please see the page "Pelvic Floor Anatomy," for further details regarding anatomy.

Clinical Presentation

An international working committee recommended the following diagnostic criteria (Rome IV) for functional constipation:

1. Must include two or more of the following:

• Straining during more than 25 percent of defecations.
• Lumpy or hard stools (Bristol Stool Scale Form 1-2) in more than 25 percent of defecations (figure 1).
• Sensation of incomplete evacuation for more than 25 percent of defecations.
• Sensation of anorectal obstruction/blockage for more than 25 percent of defecations.
• Manual maneuvers to facilitate more than 25 percent of defecations (eg, digital evacuation, support of the pelvic floor).
• Fewer than three spontaneous bowel movements per week.

2. Loose stools are rarely present without the use of laxatives

3. There are insufficient criteria for IBS. (See "Clinical manifestations and diagnosis of irritable bowel syndrome in adults".)

Although patients with functional constipation may have abdominal pain and/or bloating, they are not the predominant symptoms.

Management/Interventions

Education

Diet

Physiotherapist

Biofeedback can be a very useful tool for patients

Physician