Constipation

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

Summary

Definition

History and exam

Key diagnostic 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 years
  • African ancestry
  • lower socioeconomic status
  • family history
  • sedentary lifestyle
  • low fiber intake
  • inadequate calorie intake
  • inadequate fluid intake
  • surgical procedures and childbirth
  • medications that induce constipation
More risk factors

Diagnostic investigations

1st investigations to order

  • complete blood count (CBC)
  • 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

ACUTE

symptoms <3 months

ONGOING

symptoms >3 months

refractory to laxatives

Contributors

Authors

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

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 topic.

Amol Sharma, MD, MS

Assistant Professor

Section of Gastroenterology & Hepatology

Augusta University

Augusta

GA

Disclosures

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

Acknowledgements

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

Professor

Abteilung fur Innere Medizin

Park-Klinik Weissensee

Berlin

Germany

Disclosures

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

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 topic.

Ned Snyder, MD

Chief of Gastroenterology and Hepatology

Kelsey-Seybold Clinic

Adjunct Professor of Medicine

University of Texas Medical Branch

Houston

TX

Disclosures

Not disclosed.

  • Differentials

    • Anal fissure
    • Medication-induced constipation
    • Hypercalcemia
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  • Guidelines

    • American Gastroenterology Association Institute Guideline on the medical management of opioid-induced constipation
    • Clinical practice guideline for the evaluation and management of constipation
    More Guidelines
  • Patient leaflets

    Constipation

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