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 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
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
Investigations to consider
- defecography
- magnetic resonance defecography
- colonoscopy
- colonic transit study
- anorectal manometry
- balloon expulsion studies
- colonic manometry
Treatment algorithm
symptoms <3 months
symptoms >3 months
refractory to laxatives
Contributors
Authors
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
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
More DifferentialsGuidelines
- American Gastroenterology Association Institute Guideline on the medical management of opioid-induced constipation
- Clinical practice guideline for the evaluation and management of constipation
More GuidelinesPatient leaflets
Constipation
More Patient leaflets
Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer