constipation; dyschezia

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Introduction

Fewer than 3 stools/week, passage of hard small stools, straining & the sense of incomplete evacuation.

Chronic constipation requires >= 3 months of symptoms

Classification

  • type 1: separate hard lumps, hard to pass
  • type 2: sausage shaped & lumpy
  • type 3: sausage shaped with surface cracks
  • type 4: sausage or snake shaped, smooth & soft
  • type 5: soft blobs with clear-cut edges
  • type 6: fluffy pieces with ragged edges, mushy stool
  • type 7: watery, no solid pieces[3]

Etiology

Epidemiology

  • the most common digestive complaint in the USA
  • affects over 2% of the population
  • 2-3 times more common in women than men
  • marked increase after age 65

History

Alarm features

Clinical manifestations

Alarm features

Laboratory

Diagnostic procedures

Radiology

Complications

Differential diagnosis

Management

More general terms

More specific terms

Additional terms

References

  1. ↑ Harrison's Principles of Internal Medicine, 13th ed. Companion Handbook, Isselbacher et al (eds), McGraw-Hill Inc. NY, 1995, pg 829-39
  2. ↑ Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 297-300
  3. ↑ 3.00 3.01 3.02 3.03 3.04 3.05 3.06 3.07 3.08 3.09 3.10 Medical Knowledge Self Assessment Program (MKSAP) 11, 16, 17, 18, 19. American College of Physicians, Philadelphia 1998, 2012, 2015, 2018, 2021.
    Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022
  4. ↑ 4.0 4.1 Harrison's Principles of Internal Medicine, 14th ed. Fauci et al (eds), McGraw-Hill Inc. NY, 1998, pg 242-43
  5. ↑ 5.0 5.1 5.2 Prescriber's Letter 12(3): 2005 Constipation Myths Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=210309&pb=PRL (subscription needed) http://www.prescribersletter.com
  6. ↑ Journal Watch 25(10):82, 2005 Borowitz SM, Cox DJ, Kovatchev B, Ritterband LM, Sheen J, Sutphen J. Treatment of childhood constipation by primary care physicians: efficacy and predictors of outcome. Pediatrics. 2005 Apr;115(4):873-7. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15805358
  7. ↑ Prescriber's Letter 14(5): 2007 Medications for constipation Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=230514&pb=PRL (subscription needed) http://www.prescribersletter.com
  8. ↑ 8.0 8.1 Coccorullo P et al. Lactobacillus reuteri (DSM 17938) in infants with functional chronic constipation: A double-blind, randomized, placebo- controlled study. J Pediatr 2010 Oct; 157:598. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20542295
  9. ↑ 9.0 9.1 Kamm MA et al. Oral bisacodyl is effective and well-tolerated in patients with chronic constipation. Clin Gastroenterol Hepatol 2011 Jul; 9:577. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21440672
  10. ↑ Prescriber's Letter 19(2): 2012 CHART: Treatment of Constipation in Children GUIDELINES: Managing functional constipation in children (2011) GUIDELINES: Evaluation and Treatment of Constipation in Infants and Children: Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (2006) Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=280207&pb=PRL (subscription needed) http://www.prescribersletter.com
  11. ↑ 11.0 11.1 11.2 11.3 11.4 Geriatric Review Syllabus, 7th edition Parada JT et al (eds) American Geriatrics Society, 2010
    Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013
    Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022
  12. ↑ 12.0 12.1 12.2 12.3 12.4 12.5 Geriatrics at your Fingertips, 13th edition, 2011 Reuben DB et al (eds) American Geriatric Society
  13. ↑ Prescriber's Letter 20(4): 2013 ALGORITHM: Treatment of Constipation in Adults Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=290122&pb=PRL (subscription needed) http://www.prescribersletter.com
  14. ↑ Spiller RC, Thompson WG. Bowel disorders. Am J Gastroenterol. 2010 Apr;105(4):775-85 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20372130
  15. ↑ Rao SS, Go JT. Update on the management of constipation in the elderly: new treatment options. Clin Interv Aging. 2010 Aug 9;5:163-71. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20711435
  16. ↑ Patel M, Schimpf MO, O'Sullivan DM, LaSala CA. The use of senna with docusate for postoperative constipation after pelvic reconstructive surgery: a randomized, double-blind, placebo-controlled trial. Am J Obstet Gynecol. 2010 May;202(5):479.e1-5. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20207340
  17. ↑ van der Spoel JI, Oudemans-van Straaten HM, Kuiper MA et al Laxation of critically ill patients with lactulose or polyethylene glycol: a two-center randomized, double-blind, placebo-controlled trial. Crit Care Med. 2007 Dec;35(12):2726-31. PMID: https://www.ncbi.nlm.nih.gov/pubmed/17893628
  18. ↑ 18.0 18.1 Zaharoni H1, Rimon E, Vardi H, Friger M, Bolotin A, Shahar DR Probiotics improve bowel movements in hospitalized elderly patients--the PROAGE study. J Nutr Health Aging. 2011 Mar;15(3):215-20. PMID: 21369670
  19. ↑ 19.0 19.1 19.2 Suares NC, Ford AC. Systematic review: the effects of fibre in the management of chronic idiopathic constipation. Aliment Pharmacol Ther. 2011 Apr;33(8):895-901. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21332763
  20. ↑ 20.0 20.1 Lawton CL, Walton J, Hoyland A et al Short term (14 days) consumption of insoluble wheat bran fibre-containing breakfast cereals improves subjective digestive feelings, general wellbeing and bowel function in a dose dependent manner. Nutrients. 2013 Apr 22;5(4):1436-55. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23609776
  21. ↑ 21.0 21.1 Abbott R et al. Effect of perineal self-acupressure on constipation: A randomized controlled trial. J Gen Intern Med 2015 Apr; 30:434 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25403522 <Internet> http://link.springer.com/article/10.1007%2Fs11606-014-3084-6
    Abbott R, Hui KK. Perineal Self-Acupressure's Mechanism of Action. J Gen Intern Med. 2015 Apr;30(4):399. PMID: https://www.ncbi.nlm.nih.gov/pubmed/25666212
  22. ↑ 22.0 22.1 Hardy CL, Goliath G Constipation Associated with a Lipoma. N Engl J Med 2015; 373:656. August 13, 2015 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26267625 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMicm1413283
  23. ↑ Bharucha AE, Pemberton JH, Locke GR 3rd. American Gastroenterological Association technical review on constipation. Gastroenterology. 2013 Jan;144(1):218-38 PMID: https://www.ncbi.nlm.nih.gov/pubmed/23261065
  24. ↑ Singh S, Rao SS. Pharmacologic management of chronic constipation. Gastroenterol Clin North Am. 2010 Sep;39(3):509-27. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20951915
  25. ↑ American Gastroenterological Association. Bharucha AE, Dorn SD, Lembo A, Pressman A American Gastroenterological Association medical position statement on constipation. Gastroenterology. 2013 Jan;144(1):211-7. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23261064
  26. ↑ 26.0 26.1 Liu Z, Yan S, Wu J et al Acupuncture for Chronic Severe Functional Constipation: A Randomized, Controlled Trial. Ann Intern Med. Published online 13 September 2016 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27618593 <Internet> http://annals.org/article.aspx?articleid=2552074
  27. ↑ 27.0 27.1 Wald A. Constipation: Advances in Diagnosis and Treatment. JAMA. 2016 Jan 12;315(2):185-91. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/26757467
  28. ↑ 28.0 28.1 Dipalma JA, Cleveland MV, McGowan J, Herrera JL. A randomized, multicenter, placebo-controlled trial of polyethylene glycol laxative for chronic treatment of chronic constipation. Am J Gastroenterol. 2007 Jul;102(7):1436-41. Epub 2007 Mar 31. PMID: https://www.ncbi.nlm.nih.gov/pubmed/17403074
  29. ↑ Stern T, Davis AM. Evaluation and Treatment of Patients With Constipation. JAMA. 2016 Jan 12;315(2):192-3. No abstract available. PMID: https://www.ncbi.nlm.nih.gov/pubmed/26757468
  30. ↑ Wald A. Update on the Management of Constipation. JAMA. Published online November 4, 2019. PMID: https://www.ncbi.nlm.nih.gov/pubmed/31682683 https://jamanetwork.com/journals/jama/fullarticle/2754106
  31. ↑ 31.0 31.1 31.2 31.3 Frank C, Molnar F, Spence M Fecal incontinence in older adults. Can Fam Physician. 2020 66(4):264 PMID: https://www.ncbi.nlm.nih.gov/pubmed/32273412 PMCID: PMC7145116 Free PMC article
  32. ↑ 32.0 32.1 Gao R, Tao Y, Zhou C et al Exercise therapy in patients with constipation: a systematic review and meta-analysis of randomized controlled trials Scand J Gastroenterol. 2019 Feb;54(2):169-177 PMID: https://www.ncbi.nlm.nih.gov/pubmed/30843436 https://www.tandfonline.com/doi/abs/10.1080/00365521.2019.1568544
  33. ↑ 33.0 33.1 Gearry R, Fukudo S, Giovanni B et al Consumption of 2 Green Kiwifruits Daily Improves Constipation and Abdominal Comfort - Results of an International Multicenter Randomized Controlled Trial. Am J Gastroenterol. 2023. Jan 9 PMID: https://www.ncbi.nlm.nih.gov/pubmed/36537785 https://journals.lww.com/ajg/Fulltext/9900/Consumption_of_two_green_kiwifruit_daily_improves.592.aspx
  34. ↑ 34.0 34.1 Rao SSC et al. Randomized placebo-controlled phase 3 trial of vibrating capsule for chronic constipation. Gastroenterology 2023 Jun; 164:1202. PMID: https://www.ncbi.nlm.nih.gov/pubmed/36822371 https://www.gastrojournal.org/article/S0016-5085(23)00149-X/fulltext
  35. ↑ 35.0 35.1 Chang L et al. American Gastroenterological Association-American College of Gastroenterology clinical practice guideline: Pharmacological management of chronic idiopathic constipation. Gastroenterology 2023 Jun; 164:1086. PMID: https://www.ncbi.nlm.nih.gov/pubmed/37211380 https://www.gastrojournal.org/article/S0016-5085(23)00513-9/fulltext
  36. ↑ 36.0 36.1 Brooks M FDA Approves First Treatment for Constipation in Kids. Medscape. June 12, 2023 https://www.medscape.com/viewarticle/993074
  37. ↑ 37.0 37.1 Gearry R et al. Consumption of 2 green kiwifruits daily improves constipation and abdominal comfort
    Results of an international multicenter randomized controlled trial. Am J Gastroenterol 2023 Jun; 118:1058 PMID: https://www.ncbi.nlm.nih.gov/pubmed/36537785 PMCID: PMC10226473 Free PMC article https://journals.lww.com/ajg/Fulltext/2023/06000/Consumption_of_2_Green_Kiwifruits_Daily_Improves.26.aspx
  38. ↑ 38.0 38.1 AMA Morning Rounds. July 20, 2023 American Medical Association
  39. ↑ 39.0 39.1 Lucak S, Lunsford TN, Harris LA. Evaluation and treatment of constipation in the geriatric population. Clin Geriatr Med. 2021;37:85-102. PMID: https://www.ncbi.nlm.nih.gov/pubmed/33213776
  40. ↑ 40.0 40.1 40.2 Yang Z, Wei C, Li X et al Association Between Regular Laxative Use and Incident Dementia in UK Biobank Participants. Neurology. 2023 Apr 18;100(16):e1702-e1711. PMID: https://www.ncbi.nlm.nih.gov/pubmed/36813729 PMCID: PMC10115504 Free PMC article.
  41. ↑ National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Constipation https://www.niddk.nih.gov/health-information/digestive-diseases/constipation

Patient information

constipation patient information

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