What is Constipation?

Constipation is defined differently between patient and physician. It is commonly defined as infrequent bowel movement associated with abdominal discomfort, bloating, straining during bowel movements, or the sensation of incomplete evacuation, usually fewer than three times a week. Constipation should not be defined based on the frequency alone because it differs from person to person and this definition can lead to less diagnosis of a patient with this chronic condition.

 According to Rome IV criteria, constipation consists of two or more of the following criteria: 

  1. Straining during defecation at least 25% of the time
  2. Hard stools at least 25% of the time
  3. Incomplete evacuation at least 25% of the time
  4. Fewer than three bowel movements per week, 
  5. Rarely having loose stools without the use of laxatives

What is the epidemiology of Constipation?

Constipation is the most common gastrointestinal complaint and carries high morbidity as age increases. Approximately 4 million people in the United States have frequent constipation resulting in 2.5 million doctor visits annually. The overall prevalence of constipation in older adults ranges from 25% to 50%.  The prevalence is as high as 80% in nursing home residents and critically ill patients and associated with mortality in this population.

What are the causes of Constipation?

  • Old age and pregnancy
  • Side effects of some medicines
  • Poor diet or not enough fiber in the diet
  • Diseases of the digestive system
  • Lack of exercise
  • Not enough liquids
  • Abuse of laxatives

What are the symptoms of Constipation?

  • Having less than three bowel movements a week
  • Lumpy, dry, or hard stool
  • Straining when passing stool
  • Pain and difficulty of passing stool
  • Sensation of incomplete bowel movement
  • Stomachache, cramps or bloating

How to diagnose Constipation?

Medical history and physical examination focused on abdominal, pelvic, and rectal examinations are essential in the diagnosis of constipation. Red flag symptoms such as fatigue, fever, weight loss, or rectal bleeding may warrant additional diagnostic testing and they includes:

  • Lab testing: blood tests stool tests and urine tests 
  • Endoscopy: colonoscopy and flexible sigmoidoscopy
  • Imaging tests: lower gastrointestinal (GI) series, magnetic resonance imaging and computed tomography (CT) scan.

How to treat Constipation?

  • Lifestyle and dietary modification such as increased fluid intake and exercise
  • Increase fiber intake
  • Medication/supplement review
  • Laxatives
  • Pelvic muscle training/ biofeedback
  • Surgery if all other options fail or if constipation is caused by structural defects.

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