Last reviewed: 22 Feb 2023
Last updated: 10 Sep 2020



History and exam

Key diagnostic factors

  • presence of risk factors
  • infrequent stools
  • difficult defecation
  • sensation of incomplete evacuation
  • excessive straining
More key diagnostic factors

Other diagnostic factors

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

Risk factors

  • female sex
  • age >65
  • African ancestry
  • lower socioeconomic status
  • family history
  • sedentary lifestyle
  • low fibre intake
  • inadequate calorie intake
  • inadequate fluid intake
  • surgical procedures and childbirth
  • medicines that induce constipation
More risk factors

Diagnostic investigations

1st investigations to order

  • full blood count (FBC)
  • thyroid function tests
  • serum electrolytes, calcium, and magnesium
  • blood glucose
  • abdominal x-ray
  • barium enema
More 1st investigations to order

Investigations to consider

  • defecography
  • magnetic resonance defecography
  • colonoscopy
  • colonic transit study
  • anorectal manometry
  • balloon expulsion studies
  • colonic manometry
More investigations to consider

Treatment algorithm


symptoms <3 months


symptoms >3 months

refractory to laxatives



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




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 topic.

Amol Sharma, MD, MS

Assistant Professor

Section of Gastroenterology & Hepatology

Augusta University




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 topic. HS declares that he has no competing interests. AA is an author of one reference cited in this topic.

Peer reviewers

Stefan Muller-Lissner, MD


Abteilung fur Innere Medizin

Park-Klinik Weissensee




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




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




Not disclosed.

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  • Guidelines

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  • Patient leaflets

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