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Constipation

  • 概述
  • 理论
  • 诊断
  • 治疗
  • 随访
  • 资源
最后审阅： 18 Aug 2025
最后更新： 08 Jul 2025

小结

定义

病史和体格检查

关键诊断因素

  • infrequent stools
  • difficult defecation
  • sensation of incomplete evacuation
  • excessive straining
完整详情

其他诊断因素

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

危险因素

  • female sex
  • age >65 years
  • African ancestry
  • lower socioeconomic status
  • family history
  • sedentary lifestyle
  • low fiber intake
  • inadequate calorie intake
  • inadequate fluid intake
  • surgical procedures and childbirth
  • use of drugs that induce constipation
完整详情

诊断性检查

首要检查

  • CBC
  • thyroid function tests
  • serum electrolytes, calcium, and magnesium
  • blood glucose
  • quantitative fecal immunochemical test
  • abdominal x-ray
  • barium enema
完整详情

需考虑的检查

  • barium defecography
  • magnetic resonance defecography
  • colonoscopy
  • colonic transit study
  • anorectal manometry
  • balloon expulsion studies
  • colonic manometry
完整详情

治疗流程

急症处理

opioid-induced

not opioid-induced: symptoms <3 months

持续性治疗

not opioid-induced: symptoms ≥3 months

suspicion for dyssynergia or refractory to pharmacotherapy

撰稿人

作者

Satish Rao, MD, PhD, FRCP (Lon), FACG, AGAF
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

利益声明

SR serves on the advisory board for Vibrant Limited, Sanofi Pharmaceuticals, Viatris Pharmaceuticals, Laborie Medical Technologies, Atmo Biosciences, Ardelyx, Neurogut, Biora Therapeutics, Valeant Pharmaceuticals, Neurogut, Inc., and Takeda Pharmaceuticals. SR is an author of a number of references cited in this topic.

Dariush Shahsavari, MD

Senior Gastroenterology Fellow

Internal Medicine, Division of Gastroenterology/Hepatology

Augusta University

Augusta

GA

利益声明

DS declares that he has no competing interests.

鸣谢

Dr Satish Rao and Dr Dariush Shahsavari would like to gratefully acknowledge Dr Amol Sharma, Dr Humberto Sifuentes, and Dr Ashok Attaluri, previous contributors to this topic.

利益声明

AS declares that he is on the advisory board for Ironwood Pharmaceuticals. HS declares that he has no competing interests. AA is an author of one reference cited in this topic.

同行评议者

Stefan Muller-Lissner, MD

Professor

Abteilung fur Innere Medizin

Park-Klinik Weissensee

Berlin

Germany

利益声明

SML declares that he has no competing interests.

Eamonn M.M. Quigley, MD, FRCP, FACP, FACG, FRCPI

Professor of Medicine and Human Physiology

Department of Medicine

Clinical Sciences Building

Cork University Hospital

Cork

Ireland

利益声明

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 topic.

Ned Snyder, MD

Chief of Gastroenterology and Hepatology

Kelsey-Seybold Clinic

Adjunct Professor of Medicine

University of Texas Medical Branch

Houston

TX

利益声明

Not disclosed.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

参考文献

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

关键文献

Bharucha AE, Dorn SD, Lembo A, et al. American Gastroenterological Association medical position statement on constipation. Gastroenterology. 2013 Jan;144(1):211-7.全文  摘要

Serra J, Pohl D, Azpiroz F, et al. European society of neurogastroenterology and motility guidelines on functional constipation in adults. Neurogastroenterol Motil. 2020 Feb;32(2):e13762.全文  摘要

Alavi K, Thorsen AJ, Fang SH, et al. The American Society of Colon and Rectal Surgeons clinical practice guidelines for the evaluation and management of chronic constipation. Dis Colon Rectum. 2024 Oct 1;67(10):1244-57.全文

Crockett SD, Greer KB, Heidelbaugh JJ, et al. American Gastroenterological Association Institute guideline on the medical management of opioid-induced constipation. Gastroenterology. 2019 Jan;156(1):218-26.全文  摘要

Chang L, Chey WD, Imdad A, et al. American Gastroenterological Association-American College of Gastroenterology clinical practice guideline: pharmacological management of chronic idiopathic constipation. Am J Gastroenterol. 2023 Jun 1;118(6):936-54.全文  摘要

参考文献

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

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