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Constipation

Last reviewed: 5 Oct 2024
Last updated: 17 Apr 2024

Summary

Definition

History and exam

Key diagnostic factors

  • infrequent stools
  • difficult defecation
  • sensation of incomplete evacuation
  • excessive straining
Full details

Other diagnostic factors

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

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
Full details

Diagnostic tests

1st tests to order

  • complete blood count (CBC)
  • thyroid function tests
  • serum electrolytes, calcium, and magnesium
  • blood glucose
  • quantitative fecal immunochemical test
  • abdominal x-ray
  • barium enema
Full details

Tests to consider

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

Treatment algorithm

ACUTE

opioid-induced

not opioid-induced: symptoms <3 months

ONGOING

not opioid-induced: symptoms ≥3 months

suspicion for dyssynergia or refractory to pharmacotherapy

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 Vibrant Limited, Sanofi Pharmaceuticals, Viatris Pharmaceuticals, and Takeda Pharmaceuticals of North America. 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

Disclosures

DS declares that he has no competing interests.

Acknowledgements

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.

Disclosures

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.

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.

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