Overview
Constipation is an unsatisfactory defecation distinguished
by difficult stool passage, infrequent stools (<3 bowel movements/week), or
both, as stated in the Introduction
section.
The prevalence of constipation
ranges from 6.6-11.7% according to a survey of individuals aged 18 and above
across 33 countries. A detailed discussion about the prevalence of constipation
is in the Epidemiology
section.
The most recognized causes of constipation include sensorimotor
disturbances in the colon and pelvic floor dysfunction. Further discussions
on secondary causes of constipation are in the Etiology section.
The Pathophysiology section states that the symptoms of chronic constipation
may be due to dysfunction of intestinal motility, visceral sensitivity (eg increased
rectal sensory threshold or loss of urge to defecate), anorectal musculature,
or the enteric nervous system.
The Risk Factors section lists factors that contribute to the
development of constipation in adults.
Constipation in Adults_Disease SummaryHistory and Physical Examination
The History section states the importance of inquiring
regarding current bowel regimen, frequency, and pattern in the diagnosis of
constipation. Other information that should be asked is discussed in this
section.
The Physical Examination section emphasizes the importance of
evaluating the abdomen and other organ systems to eliminate potential causes of
chronic constipation. Discussions on rectal exams and digital rectal exams of
the rectum are also in this section.
Diagnosis
The Diagnosis or
Diagnostic Criteria section explains
functional constipation and the Rome IV diagnostic criteria.
Alarm signs and symptoms to watch out for in the diagnosis
of constipation are listed in the Screening
section.
The importance of laboratory tests such as a complete blood
count and other specific metabolic tests such as thyroid and renal function
tests in the evaluation of chronic constipation is in the Laboratory Tests and Ancillaries section.
The Imaging section emphasizes the need for imaging or
colonoscopy in the diagnosis of constipation in patients who present with alarm
symptoms or are ≥50 years of age. Specialized physiologic tests in
the evaluation of chronic constipation are also discussed in this section.
Secondary causes of constipation that should be
ruled out in the diagnosis of constipation are listed in the Differential Diagnosis section.
Management
General therapy principles and management of constipation are
in the Principles of Therapy
section.
The Pharmacological
Therapy section discusses in
detail the symptomatic therapy, such as laxatives, enemas, and other agents
prescribed in the management of constipation.
The Nonpharmacological
section includes things to educate the patient and the importance of dietary
modification in the management of constipation.
Indications for surgical referral for the treatment of
constipation are in the Surgery section.
The Monitoring
section identifies patients who do not respond to conventional therapy and
treatment options for those patients who have treatment failure for
constipation.
