Constipation
Key Points
Key Points
Figure 1A. Bristol Stool Form Scale
Figure 1B. IBS Subtypes and Stool Form
Table 1. Symptom Criteria for Constipationa
| Irritable Bowel Syndrome (IBS) |
|---|
| Criteria fulfilled for the last 3 months with symptom onset ≥6 months prior to diagnosis. |
Recurrent abdominal pain, on average, ≥1 day per week in the last 3 months, associated with ≥2 of the following criteria:
|
| IBS with predominant constipation (IBS-C): |
| More than one-fourth (25%) of bowel movements with Bristol stool form types 1 or 2 and less than one-fourth (25%) of bowel movements with Bristol stool form types 6 or 7. |
| Alternative for epidemiology or clinical practice: Patient reports that abnormal bowel movements are usually constipation (like type 1 or 2 in the picture of Bristol Stool Form Scale (BSFS), see Figure 1A). |
| Functional Constipation (FC)b |
| FC is a functional bowel disorder in which symptoms of difficult, infrequent, or incomplete defecation predominate. Patients with FC should not meet IBS criteria. Although abdominal pain and/or bloating may be present, they are not predominant symptoms. Symptom onset should occur ≥6 months before diagnosis, and symptoms should be present during the last 3 months. |
| General Definition of Constipation |
|
| Defecatory disorders |
Prolonged and excessive straining before elimination
|
| Need for perineal or vaginal pressure to allow stools to be passed or direct digital evacuation of stools |
| Diagnosis requires anorectal tests (manometry, rectal balloon expulsion, or defecography [barium or MRI]) suggestive of a defecatory disorder |
| Normal transit constipation (NTC) |
| Normal colonic transit and anorectal functions |
| Slow transit constipation (STC) |
| Slow colonic transit and normal anorectal functions |
| Combination Disorders |
| Some patients may have combination or overlap disorders (eg, STC with defecatory disorders), perhaps even associated with features of irritable bowel syndrome. |
b For research studies, patients meeting criteria for OIC should not be given a diagnosis of FC because it is difficult to distinguish between opioid side effects and other causes of constipation. However, clinicians recognize that these 2 conditions might overlap.
Figure 2. Conceptual Framework to Explain FBDs
Assessment
...Assessment...
...If feasible, discontinue medications that can c...
...ital rectal examination that includes assessme...
...ey components of the rectal examinatio...
...Te...
...of other symptoms and signs, only a...
...other clinical features warrant otherwise, me...
...hould not be performed in patients without alarm...
...etry and a rectal balloon expulsion should be pe...
...graphy should not be performed before ano...
...should be considered when results of anorect...
...transit should be evaluated if anorectal test res...
Treatment
...Treatment...
...er discontinuing medications that can cause cons...
...ts should be performed in patients...
...raining by biofeedback therapy rather th...
...Surgical Treatment...
...mptoms are refractory to simple laxatives, newer...
...l tests and colonic transit should be reevaluat...
...subtotal colectomy rather than continuing thera...
Colonic intraluminal testing (manometry, baros...
...ies or enemas rather than oral laxatives alone sh...
...eatment Algorithm for Chronic Constipation...
...e 4. Treatment Algorithm for NTC and STC...
.... Treatment Algorithm for Defecating Disor...
...rapeutic Options for IBS-C Symptom...
...eutic Options for Functional Constipation...
...ommon Drugs Causing Constipation...
...5. Summary of Dietary Supplements and Medica...