Chronic constipation is a heterogeneous disorder, and patients commonly report one or more of the following symptoms: excessive straining, a sense of incomplete evacuation, failed or lengthy attempts to defecate, hard stools, and decreased stool frequency.
A detailed history and physical examination, including a digital rectal examination, is the first step in the evaluation of constipation.
Diagnostic evaluation may include a colonoscopy if indicated, colonic transit study, anorectal manometry, and a balloon expulsion study.
Initial treatment consists of lifestyle modification and laxatives.
Medical treatment should be tailored to the underlying aetiology. Patients who do not respond to medical treatment may need specialised evaluation for pelvic floor dysfunction and biofeedback therapy. Surgery is only rarely indicated.