Constipation

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Last reviewed: 22 Jul 2025

Last updated: 08 Jul 2025

Constipation is initially evaluated with a detailed history and physical exam, including a digital rectal exam.

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 etiology. If the constipation does not respond to medical treatment, patients may need specialized evaluation for pelvic floor dysfunction and biofeedback therapy. Surgery is only rarely indicated.

Definição

Chronic constipation is a polysymptomatic heterogeneous disorder. Patients define constipation on the basis of excessive straining, a sense of incomplete evacuation, failed or lengthy attempts to defecate, hard stools, and, less frequently, by the number of stools per week.[1][2][3] The American College of Gastroenterology describes constipation as unsatisfactory defecation characterized by infrequent stools, difficult stool passage, or defecation that is both infrequent and/or difficult.[4]

This topic focuses on primary constipation (acute [<3 months] and chronic [≥3 months]) and opioid-induced constipation in adults. For constipation associated with irritable bowel syndrome, see Irritable bowel syndrome. See also Constipation in children.

História e exame físico

Principais fatores diagnósticos

infrequent stools
difficult defecation
sensation of incomplete evacuation
excessive straining

Detalhes completos

Outros fatores diagnósticos

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

Detalhes completos

Fatores de risco

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

Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

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

Detalhes completos

Investigações a serem consideradas

barium defecography
magnetic resonance defecography
colonoscopy
colonic transit study
anorectal manometry
balloon expulsion studies
colonic manometry

Detalhes completos

Algoritmo de tratamento

AGUDA

opioid-induced

not opioid-induced: symptoms <3 months

CONTÍNUA

not opioid-induced: symptoms ≥3 months

suspicion for dyssynergia or refractory to pharmacotherapy

Colaboradores

Autores

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

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

Declarações

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

Declarações

DS declares that he has no competing interests.

Agradecimentos

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.

Declarações

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.

Revisores

Stefan Muller-Lissner, MD

Professor

Abteilung fur Innere Medizin

Park-Klinik Weissensee

Berlin

Germany

Declarações

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

Declarações

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

Declarações

Not disclosed.

Referências

Nossas equipes internas de editoria e de evidências trabalham em conjunto com colaboradores internacionais especializados e pares revisores para garantir que forneçamos acesso às informações o mais clinicamente relevantes possível.

Principais artigos

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

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.Texto completo Resumo

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.Texto completo

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.Texto completo Resumo

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.Texto completo Resumo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

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Diretrizes
- Clinical practice guidelines for the evaluation and management of chronic constipation
- Pharmacological Management of Chronic Idiopathic Constipation
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Folhetos informativos para os pacientes
Constipation
Mais Folhetos informativos para os pacientes
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Constipation

Summary

Definição

História e exame físico

Principais fatores diagnósticos

Outros fatores diagnósticos

Fatores de risco

Investigações diagnósticas

Primeiras investigações a serem solicitadas

Investigações a serem consideradas

Algoritmo de tratamento

opioid-induced

not opioid-induced: symptoms <3 months

not opioid-induced: symptoms ≥3 months

suspicion for dyssynergia or refractory to pharmacotherapy

Colaboradores

Autores

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

Declarações

Dariush Shahsavari, MD

Declarações

Agradecimentos

Declarações

Revisores

Stefan Muller-Lissner, MD

Declarações

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

Declarações

Ned Snyder, MD

Declarações

Referências

Principais artigos

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais

Diretrizes

Folhetos informativos para os pacientes

Conectar-se ou assinar para acessar todo o BMJ Best Practice

Conectar-se ou assinar para acessar todo o BMJ Best Practice

Conectar-se para acessar todo o BMJ Best Practice