Last reviewed: November 2017
Last updated: November  2017

Summary

Definition

History and exam

Key diagnostic factors

  • infrequent stools
  • difficult defecation
  • sensation of incomplete evacuation
  • excessive straining

Other diagnostic factors

  • hard stools
  • abdominal mass
  • signs suggestive of underlying medical disorder
  • anorectal lesions
  • abnormality on digital rectal examination (DRE)

Risk factors

  • female gender
  • age >65 years
  • black ancestry
  • lower socioeconomic status
  • FHx
  • sedentary lifestyle
  • low fiber intake
  • inadequate calorie intake
  • inadequate fluid intake
  • surgical procedures and childbirth
  • medications that induce constipation

Diagnostic investigations

1st investigations to order

  • CBC
  • TFTs
  • serum electrolytes, calcium, and magnesium
  • blood glucose
  • abdominal x-ray
  • barium enema
Full details

Investigations to consider

  • defecography
  • MR defecography
  • colonoscopy
  • colonic transit study
  • anorectal manometry
  • balloon expulsion studies
  • colonic manometry
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Satish Rao

Professor of Medicine

Chief, Section of Gastroenterology and Hepatology

Director, Digestive Health Center and Neurogastroenterology and GI Motility

Medical College of Georgia

Georgia Regents University

Augusta

GA

Disclosures

SR serves on the advisory board for Smartpill Corporation, Greenwood Pharmaceuticals, Forest Research Institute, and Takeda Pharmaceuticals of North America. SR is an author of a reference cited in this monograph.

Assistant Professor

Section of Gastroenterology & Hepatology

Augusta University

Augusta

GA

Disclosures

AS declares that he is on the advisory board for Ironwood Pharmaceuticals.

Dr Satish Rao and Dr Amol Sharma would like to gratefully acknowledge Dr Humberto Sifuentes and Dr Ashok Attaluri, previous contributors to this monograph. HS declares that he has no competing interests. AA is an author of one reference cited in this monograph.

Peer reviewers VIEW ALL

Professor

Abteilung fur Innere Medizin

Park-Klinik Weissensee

Berlin

Germany

Disclosures

SML declares that he has no competing interests.

Professor of Medicine and Human Physiology

Department of Medicine

Clinical Sciences Building

Cork University Hospital

Cork

Ireland

Disclosures

EMMQ has served as a consultant or on advisory boards for the following companies: Sucampo, Movetis, Norgine, Procter and Gamble, Boehringer Ingelheim, Reckitts Benckiser, Schering, Novartis, Salix, Ironwood, and McNeill Consumer Health and has been paid for his time involved. EMMQ is an author of several references cited in this monograph.

Chief of Gastroenterology and Hepatology

Kelsey-Seybold Clinic

Adjunct Professor of Medicine

University of Texas Medical Branch

Houston

TX

Disclosures

Not disclosed.

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