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
...Asse...
...le, discontinue medications that can cause...
...A careful digital rectal examination t...
...nts of the rectal examination include:...
...Testing for Medi...
...sence of other symptoms and signs, only a...
...ther clinical features warrant otherwise, metabol...
...copy should not be performed in pati...
...norectal manometry and a rectal ball...
Defecography should not be performed be...
...uld be considered when results of anorectal manom...
...nsit should be evaluated if anorectal test re...
Treatment
...Trea...
...discontinuing medications that can...
...ectal tests should be performed in patients...
...lvic floor retraining by biofeedback therapy r...
...Surgical Treatment...
...ymptoms are refractory to simple laxatives, n...
...and colonic transit should be reevaluate...
...colectomy rather than continuing therapy with...
...luminal testing (manometry, barostat) should be...
...ies or enemas rather than oral lax...
...reatment Algorithm for Chronic Constipation...
Figure 4. Treatment Algorithm f...
...Treatment Algorithm for Defecating Disorders...
...apeutic Options for IBS-CHaving trouble v...
...3. Therapeutic Options for Functional C...
.... Common Drugs Causing ConstipationH...
...mmary of Dietary Supplements and Me...