Materiały źródłowe

• #1 Constipation: Symptoms & Causes

  https://my.clevelandclinic.org/health/diseases/4059-constipation

  Constipation occurs when your bowel movements become less frequent and stools become difficult to pass. You should call a healthcare provider if you have severe pain, blood in your stool or constipation that lasts longer than three weeks. Having fewer than three bowel movements a week is, technically, the definition of constipation. Other key features that usually define constipation include: Your stools are dry and hard. Your bowel movements are painful, and your stools are difficult to pass. You have a feeling that you haven’t fully emptied your bowels. Constipation is one of the most frequent gastrointestinal complaints in the United States. At least 2.5 million people see their healthcare provider each year due to constipation. […] Talking to a healthcare provider or anyone about your bowel movements (or lack of them) may not be the most pleasant of topics. Your provider will begin by asking you questions about your medical history, bowel movements, lifestyle and routines. Your healthcare provider may not order any tests or may order many types of tests and procedures. Tests will depend on your symptoms, medical history, and overall health and what they think the cause might be. Most of the time, additional lab testing isn’t required for a diagnosis.

• #2 Diagnostic Approach to Chronic Constipation in Adults | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/0801/p299.html

  Constipation is traditionally defined as three or fewer bowel movements per week. […] The evaluation of constipation includes a history and physical examination to rule out alarm signs and symptoms. […] Patients with one or more alarm signs or symptoms require prompt evaluation. […] The initial management of noncomplicated constipation should include a high-fiber diet, increased water intake, and exercise. […] The physician should begin by inquiring about which features the patient finds most distressing. […] The physical examination should include an abdominal and rectal examination, looking for signs of anemia, weight loss, abdominal masses, liver enlargement, or a palpable colon. […] Diagnostic tests (e.g., blood tests, radiography, endoscopy) are not routinely recommended in the initial evaluation of a patient with chronic constipation in the absence of alarm signs or symptoms.

• #3 Constipation – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK513291/

  Constipation is a symptom or condition characterized by difficult and infrequent bowel movements, typically 3 or fewer times a week. It is one of the most common gastrointestinal complaints in the United States and a common reason for referral to colorectal surgeons and gastroenterologists. Constipation is a prevalent condition that often remains unrecognized until the patient starts having sequelae, such as anorectal disorders. […] Understanding these subtypes is pivotal for healthcare professionals as it guides tailored approaches to diagnosis and treatment, optimizing patient care and outcomes. […] The diagnosis of constipation should not rely simply on asking the patient whether they are constipated, as this limited inquiry is associated with significant underreporting in patients with physical evidence of constipation, including hemorrhoidal disease. Therefore, a thorough history should be obtained, including the history of medications, previous colonoscopies, surgeries, and underlying or pertinent medical issues. […] Adult and pediatric Rome IV criteria are helpful in making the diagnosis of functional constipation.

• #4 Constipation & Defecation Problems | ACG

  https://gi.org/topics/constipation-and-defection-problems/

  Constipation is one of the most frequent gastrointestinal complaints in the USA and Western countries. There are at least 2.5 million doctor visits for constipation in the USA each year, and hundreds of millions of dollars are spent on laxatives yearly. […] A doctor usually depends on the patients’ history while making a diagnosis. The doctor also examines the rectum with a gloved finger and, if stool is present, determines the amount and consistency. The stool is tested for occult (hidden) blood. A good history and physical examination is all that is needed to confirm a diagnosis of constipation and to determine the likely cause. […] When the cause remains unclear, tests may be done. The doctor may advise an examination with a flexible viewing tube, either of just the lower part of the large intestine (sigmoidoscopy) or of the entire large intestine (colonoscopy). This examination is important if the constipation developed suddenly or if there is hidden blood in the stool.

• #5 Diagnostic Approach to Chronic Constipation in Adults | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/0801/p299.html

  Constipation is traditionally defined as three or fewer bowel movements per week. […] The evaluation of constipation includes a history and physical examination to rule out alarm signs and symptoms. […] Patients with one or more alarm signs or symptoms require prompt evaluation. […] The initial management of noncomplicated constipation should include a high-fiber diet, increased water intake, and exercise. […] The physician should begin by inquiring about which features the patient finds most distressing. […] The physical examination should include an abdominal and rectal examination, looking for signs of anemia, weight loss, abdominal masses, liver enlargement, or a palpable colon. […] Diagnostic tests (e.g., blood tests, radiography, endoscopy) are not routinely recommended in the initial evaluation of a patient with chronic constipation in the absence of alarm signs or symptoms.

• #6 Diagnosis and management of chronic constipation in adults | Nature Reviews Gastroenterology & Hepatology

  https://www.nature.com/articles/nrgastro.2016.53

  Constipation is common, impairs quality of life and consumes considerable health-care resources. […] Recognition of whether constipation is primary or secondary is key for appropriate management. […] A detailed history and physical examination including digital rectal examination is important and can identify an evacuation disorder. […] Physiological tests such as colonic transit assessment, anorectal manometry and the balloon expulsion test can facilitate stratification of patients with different constipation subtypes. […] Newer drugs, such as linaclotide and lubiprostone, laxatives, and biofeedback therapy can considerably improve symptoms in patients with chronic constipation. […] A diagnosis of primary chronic constipation is made after exclusion of secondary causes of constipation and encompasses several overlapping subtypes.

• #7 Constipation – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/constipation/diagnosis-treatment/drc-20354259

  In addition to giving you a general physical exam, your health care professional will likely do the following during your appointment: […] You’ll also be asked questions about your medical history, diet, exercise habits and stools. For some people, the information from this appointment may be enough for a diagnosis and treatment plan. […] For other people, one or more additional tests may be needed to help the health care team understand the nature or cause of constipation. […] Your health care professional may send samples of your blood to a lab to test for diseases or conditions that can cause constipation. […] Your health care professional may order a procedure called an endoscopy. A small tube with a camera is guided into the colon. This can reveal the condition of the colon or the presence of irregular tissues.

• #8 Diagnosing Constipation | Stanford Health Care

  https://stanfordhealthcare.org/medical-conditions/primary-care/constipation/diagnosis.html

  Most people experience occasional constipation. If you are suffering from chronic or severe constipation, there are a number of different ways your doctor can help diagnose the problem. […] It is important for your doctor to understand your medical history to address common factors that often contribute to constipation. This may include questions regarding: […] Your doctor may find it necessary to conduct a physical examination, known as a digital rectal exam (DRE). This exam can help diagnose problems in the colon (large intestine) that commonly causes constipation, such as: […] If patient history or a digital rectal exam are not able to find the cause of constipation, there are several other diagnostic tools and tests that can be used:

• #9 Constipation: Diagnosis & Treatment | NewYork-Presbyterian

  https://www.nyp.org/primary-care/constipation/treatment

  How is Constipation Diagnosed? Diagnosis Your primary care doctor will examine your medical and family history, then perform a physical exam to diagnose constipation. […] Depending on the conspitation symptoms, your doctor may first try a treatment to improve the symptoms before ordering tests. […] Medical history. Your doctor may ask you about any recent weight loss or gain or past digestive tract surgery. Your doctor may also question you about your family medical history, such as whether you have any other family members with a history of constipation problems. […] Physical exam. A healthcare professional may check your abdomen for swelling, tenderness, pain, masses, or lumps during a physical exam. They may also perform a rectal exam. […] Lab tests, including blood, stool, and urine tests.

• #10 SciELO Brazil – DIAGNOSIS AND MANAGEMENT OF CHRONIC IDIOPATHIC CONSTIPATION: A NARRATIVE REVIEW FROM A BRAZILIAN EXPERT TASK FORCE DIAGNOSIS AND MANAGEMENT OF CHRONIC IDIOPATHIC CONSTIPATION: A NARRATIVE REVIEW FROM A BRAZILIAN EXPERT TASK FORCE

  https://www.scielo.br/j/ag/a/zwRh8ZSwMnsdFMJZVTHv8Dj/

  A detailed clinical history should be obtained, including time of symptoms onset, dietary/fiber intake characteristics as well as history of physical/sexual abuse and obstetric events. […] According to Rome IV criteria, CIC is diagnosed based on symptoms, such as straining during more than 25% of defecations, sensation of incomplete evacuation more than 25% of defecations and other symptoms. […] The diagnosis of CIC can be based mainly on symptoms alone; therefore, a careful medical history is critical and should assess the presence of symptoms, their duration, and progression. […] Currently, the criteria most in use for definition of CIC are those of the Rome IV. […] Medical history is an important part of the diagnosis and should include: age, family history of colon cancer (or familial polyposis syndromes), frequency of bowel movements, associated symptoms (e.g. abdominal pain, bloating, or distension), an assessment of stool consistency, stool size, and degree of straining during defecation.

• #11 Evaluation of Constipation | AAFP

  https://www.aafp.org/pubs/afp/issues/2002/0601/p2283.html

  The evaluation begins with clarification of what the patient means by constipation. […] Acute constipation is more often associated with organic disease than is long-standing constipation. […] It is important to determine whether the patient has a history or signs and symptoms of a neurologic, endocrine, or metabolic disorder. […] The patient must be asked about red flags that suggest the presence of an underlying gastrointestinal organic disorder. […] The physical examination is directed at identifying underlying causes of constipation. […] Laboratory studies and colorectal imaging are appropriate when constipation is persistent and fails to respond to conservative treatment, or when a particular disorder is suspected. […] Flexible sigmoidoscopy and colonoscopy are excellent for identifying lesions that narrow or occlude the bowel.

• #12 Constipation: Causes, Symptoms, and Treatment

  https://www.webmd.com/digestive-disorders/digestive-diseases-constipation

  Your doctor will start by asking you questions about your medical history, lifestyle and habits, and your bowel movements. They’ll also do a physical exam, and they may do a rectal exam. This is a quick exam in which your doctor inserts a finger into your rectum to check for any problems, such as a lump. […] Your doctor may recommend some other tests to find the cause of your constipation: […] Blood, stool, and urine tests: These look for any problems with your hormones, or conditions such as diabetes, anemia, and cancer. They also show if there is an infection or inflammation. […] Colonoscopy or sigmoidoscopy: Your doctor inserts a tiny camera into your rectum and colon to look for any issues. […] Imaging tests: X-ray, CT scan, or MRI scan are other ways your doctor can look for anything unusual in your digestive system. […] Bowel function tests: Defecography, anorectal manometry, balloon expulsion, radiopaque marker, and scintigraphy are all tests that see how your colon is working and how poop moves through and out of your colon.

• #13 Evaluation of Constipation | AAFP

  https://www.aafp.org/pubs/afp/issues/2002/0601/p2283.html

  Although constipation can have many causes, it is most often functional or idiopathic. […] The exact prevalence of constipation in the U.S. population is not known, although one epidemiologic study found an overall prevalence of 14.7 percent. […] In adults, constipation occurs more frequently in blacks and women, and usually becomes more prevalent with increasing age. […] Constipation affects 3 percent of preschool-age children and 1 to 2 percent of school-age children; in the latter group, constipation is more common in boys. […] Constipation has different meanings to different people. […] An international committee has recommended operational definitions of chronic functional constipation in adults, infants, and young children. […] A thorough investigation of constipation may be indicated for one of two reasons: (1) to exclude systemic disease or a structural disorder of the intestines, or (2) to elucidate the underlying pathophysiologic process when constipation does not respond to simple treatment.

• #14 Diagnostic Approach to Chronic Constipation in Adults | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/0801/p299.html

  Constipation is traditionally defined as three or fewer bowel movements per week. […] The evaluation of constipation includes a history and physical examination to rule out alarm signs and symptoms. […] Patients with one or more alarm signs or symptoms require prompt evaluation. […] The initial management of noncomplicated constipation should include a high-fiber diet, increased water intake, and exercise. […] The physician should begin by inquiring about which features the patient finds most distressing. […] The physical examination should include an abdominal and rectal examination, looking for signs of anemia, weight loss, abdominal masses, liver enlargement, or a palpable colon. […] Diagnostic tests (e.g., blood tests, radiography, endoscopy) are not routinely recommended in the initial evaluation of a patient with chronic constipation in the absence of alarm signs or symptoms.

• #15 Constipation: Diagnosis & Treatment | NewYork-Presbyterian

  https://www.nyp.org/primary-care/constipation/treatment

  How is Constipation Diagnosed? Diagnosis Your primary care doctor will examine your medical and family history, then perform a physical exam to diagnose constipation. […] Depending on the conspitation symptoms, your doctor may first try a treatment to improve the symptoms before ordering tests. […] Medical history. Your doctor may ask you about any recent weight loss or gain or past digestive tract surgery. Your doctor may also question you about your family medical history, such as whether you have any other family members with a history of constipation problems. […] Physical exam. A healthcare professional may check your abdomen for swelling, tenderness, pain, masses, or lumps during a physical exam. They may also perform a rectal exam. […] Lab tests, including blood, stool, and urine tests.

• #16 Diagnosing Constipation | Stanford Health Care

  https://stanfordhealthcare.org/medical-conditions/primary-care/constipation/diagnosis.html

  Most people experience occasional constipation. If you are suffering from chronic or severe constipation, there are a number of different ways your doctor can help diagnose the problem. […] It is important for your doctor to understand your medical history to address common factors that often contribute to constipation. This may include questions regarding: […] Your doctor may find it necessary to conduct a physical examination, known as a digital rectal exam (DRE). This exam can help diagnose problems in the colon (large intestine) that commonly causes constipation, such as: […] If patient history or a digital rectal exam are not able to find the cause of constipation, there are several other diagnostic tools and tests that can be used:

• #17 Guidelines for the Diagnosis and Treatment of Chronic Functional Constipation in Korea, 2015 Revised Edition

  https://www.jnmjournal.org/journal/view.html?uid=1143&vmd=Full

  Colonoscopy should be performed to exclude conditions of secondary constipation in patients with chronic constipation if the patients have alarm symptoms, such as blood in the stool, anemia, unexplained weight loss, new-onset constipation, or a family history of colon cancer. […] Digital rectal examination is useful for the differential diagnosis of secondary constipation (rectoanal mass, rectal prolapse, and rectocele) and predicting defecatory disorders. […] Anorectal manometry is useful for diagnosing defecatory disorders in patients with constipation who fail to respond to laxatives. […] Balloon expulsion tests may be helpful in predicting defecatory disorders, but other rectoanal physiological tests should be performed to confirm the diagnosis. […] Defecography is useful for detecting anatomical abnormalities and paradoxical contraction of the pelvic floor when defecatory disorders are suspected in patients with chronic constipation.

• #18 Diagnosis and management of chronic constipation in adults | Nature Reviews Gastroenterology & Hepatology

  https://www.nature.com/articles/nrgastro.2016.53

  Slow-transit constipation is characterized by prolonged colonic transit in the absence of pelvic floor dysfunction. […] This subtype of constipation can be identified using either the radio-opaque marker test or wireless motility capsule test, and is best treated with laxatives such as polyethylene glycol or newer agents such as linaclotide or lubiprostone. […] Dyssynergic defecation results from impaired coordination of rectoanal and pelvic floor muscles, and causes difficulty with defecation. […] The condition can be identified using anorectal manometry and balloon expulsion tests and is best managed with biofeedback therapy. […] Opioid-induced constipation is an emerging entity, and several drugs including naloxegol, methylnaltrexone and lubiprostone are approved for its treatment. […] In this Review, we provide an overview of the burden and pathophysiology of chronic constipation, as well as a detailed discussion of the available diagnostic tools and treatment options.

• #19 Evaluation and management of constipation – American Gastroenterological AssociationAGA Logo_Horizontal

  https://gastro.org/clinical-guidance/evaluation-and-management-of-constipation/

  Evaluation and management of constipation. […] Recommendations for the assessment and therapeutic treatment of constipation. […] 1. If feasible, discontinue medications that can cause constipation before further testing. 2. A careful digital rectal examination that includes assessment of pelvic floor motion during simulated evacuation is preferable to a cursory examination without these maneuvers and should be performed before referral for anorectal manometry. However, a normal digital rectal examination does not exclude defecatory disorders. 3. In the absence of other symptoms and signs, only a complete blood cell count is necessary. 4. Unless other clinical features warrant otherwise, metabolic tests (glucose, calcium, sensitive thyroid-stimulating hormone) are not recommended for chronic constipation. 5. A colonoscopy should not be performed in patients without alarm features (eg, blood in stools, anemia, weight loss) unless age-appropriate colon cancer screening has not been performed. 6. Anorectal manometry and a rectal balloon expulsion should be performed in patients who fail to respond to laxatives. 7. Defecography should not be performed before anorectal manometry and a rectal balloon expulsion test. 8. Defecography should be considered when results of anorectal manometry and rectal balloon expulsion are inconclusive for defecatory disorders. 9. Colonic transit should be evaluated if anorectal test results do not show a defecatory disorder or if symptoms persist despite treatment of a defecatory disorder. 10. After discontinuing medications that can cause constipation and performing blood and other tests as guided by clinical features, a therapeutic trial (ie, fiber supplementation and/or osmotic or stimulant laxatives) is recommended before anorectal testing. 11. Normal transit constipation (NTC) and slow transit constipation (STC) can be safely managed with long-term use of laxatives. 12. Anorectal tests should be performed in patients who do not respond to these measures. 13. Pelvic floor retraining by biofeedback therapy rather than laxatives is recommended for defecatory disorders. 14. When bowel symptoms are refractory to simple laxatives, newer agents should be considered in patients with NTC or STC. 15. Anorectal tests and colonic transit should be reevaluated when symptoms persist despite an adequate trial of biofeedback therapy. 16. A subtotal colectomy rather than continuing therapy with chronic laxatives should be considered for patients with symptomatic STC without a defecatory disorder. 17. Colonic intraluminal testing (manometry, barostat) should be considered to document colonic motor dysfunction before colectomy. 18. Suppositories or enemas rather than oral laxatives alone should be considered in patients with refractory pelvic floor dysfunction.

• #20 Diagnosis of Chronic Constipation

  https://www.kjg.or.kr/journal/view.html?pn=vol&uid=6017

  Patients with chronic constipation (CC) usually complain of mild to severe symptoms, including hard or lumpy stools, straining, a sense of incomplete evacuation after a bowel movement, a feeling of anorectal blockage, the need for digital maneuver to assist defecation, or reduced stool frequency. […] In clinical practice, healthcare providers need to check for alarm features indicative of a colonic malignancy, such as bloody stools, anemia, unexplained weight loss, or new-onset symptoms after 50 years of age. […] In the Seoul Consensus on the diagnosis and treatment of chronic constipation, the Bristol stool form scale, colonoscopy, and digital rectal examination are useful for objectively evaluating the symptoms and making a differential diagnosis of the secondary cause of constipation.

• #21 Constipation: Symptoms, diagnosis and treatment. Clínica Universidad de Navarra

  https://www.cun.es/en/diseases-treatments/diseases/constipation

  „Colonoscopy is recommended for all patients with constipation who have: anemia, rectal bleeding, obstructive symptoms, recent onset of constipation, weight loss, rectal prolapse, change in stool size, or who are over 50 years old and have not been screened for colon cancer”. […] Given the number of circumstances that may be related to the appearance of constipation, it should be the doctor, after knowing the dietary habits, the taking of drugs and the existence of other diseases, who determines what studies are necessary to do. […] In the event that it seems that the most likely cause may be a tumor, the intestine must be studied from the inside by means of a colonoscopy. […] Constipation represents a very frequent reason for consultation. Any person at any age can present seasons of constipation, especially coinciding with changes of diet or travel.

• #22 How Constipation Is Diagnosed in Adults

  https://www.verywellhealth.com/how-constipation-is-diagnosed-4685091

  During your physical examination, your healthcare provider will check your vitals and weight and then inspect and press on your abdomen to evaluate for swelling, tenderness, and masses or lumps. […] Moreover, your healthcare provider may also ask you to strain (like when having a bowel movement) to identify potential rectal prolapse, fecal impaction, or pelvic floor dysfunction. […] Depending on findings from your medical history and physical exam, various blood tests and/or a colonoscopy may be ordered. […] Colonoscopy is not generally recommended for adults with constipation. However, if the below symptoms are present, an endoscopy evaluation is generally warranted to rule out cancer or other serious conditions: rectal bleeding, positive fecal occult blood test, indicating there is blood in your stool, iron deficiency anemia, unintended weight loss of more than 5% of your total body weight, intestinal obstructive symptoms, recent onset of constipation without an obvious explanation, family history of colon cancer or rectal cancer, family history of inflammatory bowel disease.

• #23 Constipation – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/constipation/symptoms-causes/syc-20354253

  Constipation is a problem with passing stool. Constipation generally means passing fewer than three stools a week or having a difficult time passing stool. […] Constipation is usually treated with changes in diet and exercise or with nonprescription medicines. Constipation may require medicines, changes in medicines or other treatments prescribed by a health care professional. […] Chronic constipation is having two or more of these symptoms for three months or longer. […] Make an appointment with your health care professional if you have constipation with any of the following conditions: Symptoms that last longer than three weeks. […] In general, constipation occurs when stool moves too slowly through the large intestine, also called the colon. […] The ability both to relax these muscles and to bear down are necessary to pass stool from the rectum.

• #24 Diagnostic Approach to Chronic Constipation in Adults | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/0801/p299.html

  Constipation is traditionally defined as three or fewer bowel movements per week. […] The evaluation of constipation includes a history and physical examination to rule out alarm signs and symptoms. […] Patients with one or more alarm signs or symptoms require prompt evaluation. […] The initial management of noncomplicated constipation should include a high-fiber diet, increased water intake, and exercise. […] The physician should begin by inquiring about which features the patient finds most distressing. […] The physical examination should include an abdominal and rectal examination, looking for signs of anemia, weight loss, abdominal masses, liver enlargement, or a palpable colon. […] Diagnostic tests (e.g., blood tests, radiography, endoscopy) are not routinely recommended in the initial evaluation of a patient with chronic constipation in the absence of alarm signs or symptoms.

• #25 Evaluation of Constipation | AAFP

  https://www.aafp.org/pubs/afp/issues/2002/0601/p2283.html

  The evaluation begins with clarification of what the patient means by constipation. […] Acute constipation is more often associated with organic disease than is long-standing constipation. […] It is important to determine whether the patient has a history or signs and symptoms of a neurologic, endocrine, or metabolic disorder. […] The patient must be asked about red flags that suggest the presence of an underlying gastrointestinal organic disorder. […] The physical examination is directed at identifying underlying causes of constipation. […] Laboratory studies and colorectal imaging are appropriate when constipation is persistent and fails to respond to conservative treatment, or when a particular disorder is suspected. […] Flexible sigmoidoscopy and colonoscopy are excellent for identifying lesions that narrow or occlude the bowel.

• #26 Constipation – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/154

  Constipation is initially evaluated with a detailed history and physical examination, including a digital rectal examination. […] Diagnostic evaluation may include a colonoscopy if indicated, colonic transit study, anorectal manometry, and a balloon expulsion study. […] Medical treatment should be tailored to the underlying aetiology. If the constipation does not respond to medical treatment, patients may need specialised evaluation for pelvic floor dysfunction and biofeedback therapy. […] Key diagnostic factors include presence of risk factors, infrequent stools, difficult defecation, sensation of incomplete evacuation, and excessive straining. […] Other diagnostic factors include hard stools, abdominal mass, signs suggestive of underlying medical disorder, anorectal lesions, and abnormality on digital rectal examination (DRE).

• #27 Constipation – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK513291/

  An extensive workup of the patient with constipation should be performed on an outpatient basis. Usually, the workup starts after 3 to 6 months of failed medical management. […] Laboratory investigations do not play a significant role in the initial evaluation of constipation. […] The treatment of adults with constipation involves a comprehensive approach that addresses the underlying causes and focuses on promoting regular bowel movements and symptom relief. […] Treating adults with secondary constipation involves addressing the underlying causes or contributing factors that have led to this condition. […] Differential diagnosis of constipation is extensive and inclusive of: abdominal hernias, anal fissure, anorectal malformations, anxiety disorders, appendicitis, colorectal cancer, colonic obstruction, Crohn disease, depression, and more. […] Most patients with constipation are managed well with holistic treatment, and most improve.

• #28 Evaluation and management of constipation – American Gastroenterological AssociationAGA Logo_Horizontal

  https://gastro.org/clinical-guidance/evaluation-and-management-of-constipation/

  Evaluation and management of constipation. […] Recommendations for the assessment and therapeutic treatment of constipation. […] 1. If feasible, discontinue medications that can cause constipation before further testing. 2. A careful digital rectal examination that includes assessment of pelvic floor motion during simulated evacuation is preferable to a cursory examination without these maneuvers and should be performed before referral for anorectal manometry. However, a normal digital rectal examination does not exclude defecatory disorders. 3. In the absence of other symptoms and signs, only a complete blood cell count is necessary. 4. Unless other clinical features warrant otherwise, metabolic tests (glucose, calcium, sensitive thyroid-stimulating hormone) are not recommended for chronic constipation. 5. A colonoscopy should not be performed in patients without alarm features (eg, blood in stools, anemia, weight loss) unless age-appropriate colon cancer screening has not been performed. 6. Anorectal manometry and a rectal balloon expulsion should be performed in patients who fail to respond to laxatives. 7. Defecography should not be performed before anorectal manometry and a rectal balloon expulsion test. 8. Defecography should be considered when results of anorectal manometry and rectal balloon expulsion are inconclusive for defecatory disorders. 9. Colonic transit should be evaluated if anorectal test results do not show a defecatory disorder or if symptoms persist despite treatment of a defecatory disorder. 10. After discontinuing medications that can cause constipation and performing blood and other tests as guided by clinical features, a therapeutic trial (ie, fiber supplementation and/or osmotic or stimulant laxatives) is recommended before anorectal testing. 11. Normal transit constipation (NTC) and slow transit constipation (STC) can be safely managed with long-term use of laxatives. 12. Anorectal tests should be performed in patients who do not respond to these measures. 13. Pelvic floor retraining by biofeedback therapy rather than laxatives is recommended for defecatory disorders. 14. When bowel symptoms are refractory to simple laxatives, newer agents should be considered in patients with NTC or STC. 15. Anorectal tests and colonic transit should be reevaluated when symptoms persist despite an adequate trial of biofeedback therapy. 16. A subtotal colectomy rather than continuing therapy with chronic laxatives should be considered for patients with symptomatic STC without a defecatory disorder. 17. Colonic intraluminal testing (manometry, barostat) should be considered to document colonic motor dysfunction before colectomy. 18. Suppositories or enemas rather than oral laxatives alone should be considered in patients with refractory pelvic floor dysfunction.

• #29 Constipation – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/constipation/diagnosis-treatment/drc-20354259

  In addition to giving you a general physical exam, your health care professional will likely do the following during your appointment: […] You’ll also be asked questions about your medical history, diet, exercise habits and stools. For some people, the information from this appointment may be enough for a diagnosis and treatment plan. […] For other people, one or more additional tests may be needed to help the health care team understand the nature or cause of constipation. […] Your health care professional may send samples of your blood to a lab to test for diseases or conditions that can cause constipation. […] Your health care professional may order a procedure called an endoscopy. A small tube with a camera is guided into the colon. This can reveal the condition of the colon or the presence of irregular tissues.

• #30 Constipation – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/154

  1st investigations to order include full blood count (FBC), thyroid function tests, serum electrolytes, calcium, and magnesium, blood glucose, quantitative faecal immunochemical test, abdominal x-ray, and barium enema. […] Investigations to consider include barium defecography, magnetic resonance defecography, colonoscopy, colonic transit study, anorectal manometry, balloon expulsion studies, and colonic manometry.

• #31 10 Differential Diagnoses for Your Constipation Patients

  https://www.rupahealth.com/post/10-differential-diagnoses-for-your-constipation-patients

  Functional constipation has no identifiable underlying disease process and is the consequence of behavioral and environmental factors. Delaying defecation, a low-fiber diet, dehydration, a sedentary lifestyle, and psychological stress can all contribute to constipation. […] Blood work should be ordered to rule out causes of secondary constipation. A complete blood count (CBC), comprehensive metabolic panel (CMP), thyroid panel, and hemoglobin A1c (HbA1c) can assess for imbalances in blood cells, electrolytes, blood sugar, and thyroid hormones. […] A comprehensive stool test utilizes multiple assessment technologies to analyze the intestinal microbiome and screen for bacterial, fungal, and parasitic infections contributing to constipation and other gastrointestinal symptoms. […] Depending on the patient’s response to first-line therapies and lab results, imaging studies may be required to work up the cause of constipation further.

• #32 Chronic Constipation Diagnosis | Stanford Health Care

  https://stanfordhealthcare.org/medical-conditions/digestion-and-metabolic-health/chronic-constipation/diagnosis.html

  Abdominal X-ray: A standard X-ray of your small intestine to identify abnormalities or blockages […] Anorectal manometry: Measuring muscle strength in your anus with the help of a thin plastic probe we place in your rectum. This test also measures sensation and reflex activity. […] Barium enema/lower GI series: X-ray study of your rectum, large intestine, and the lower part of your small intestine using a special dye containing barium. This chemical helps show the fine details of your intestines. […] Blood tests: Using a sample of your blood, we may run a number of tests including: […] Complete blood count to look for signs of anemia and infections […] Electrolyte and kidney function panel to look for electrolyte abnormalities and liver issues […] Albumin tests to assess your nutritional status

• #33 Evaluation and management of constipation – American Gastroenterological AssociationAGA Logo_Horizontal

  https://gastro.org/clinical-guidance/evaluation-and-management-of-constipation/

  Evaluation and management of constipation. […] Recommendations for the assessment and therapeutic treatment of constipation. […] 1. If feasible, discontinue medications that can cause constipation before further testing. 2. A careful digital rectal examination that includes assessment of pelvic floor motion during simulated evacuation is preferable to a cursory examination without these maneuvers and should be performed before referral for anorectal manometry. However, a normal digital rectal examination does not exclude defecatory disorders. 3. In the absence of other symptoms and signs, only a complete blood cell count is necessary. 4. Unless other clinical features warrant otherwise, metabolic tests (glucose, calcium, sensitive thyroid-stimulating hormone) are not recommended for chronic constipation. 5. A colonoscopy should not be performed in patients without alarm features (eg, blood in stools, anemia, weight loss) unless age-appropriate colon cancer screening has not been performed. 6. Anorectal manometry and a rectal balloon expulsion should be performed in patients who fail to respond to laxatives. 7. Defecography should not be performed before anorectal manometry and a rectal balloon expulsion test. 8. Defecography should be considered when results of anorectal manometry and rectal balloon expulsion are inconclusive for defecatory disorders. 9. Colonic transit should be evaluated if anorectal test results do not show a defecatory disorder or if symptoms persist despite treatment of a defecatory disorder. 10. After discontinuing medications that can cause constipation and performing blood and other tests as guided by clinical features, a therapeutic trial (ie, fiber supplementation and/or osmotic or stimulant laxatives) is recommended before anorectal testing. 11. Normal transit constipation (NTC) and slow transit constipation (STC) can be safely managed with long-term use of laxatives. 12. Anorectal tests should be performed in patients who do not respond to these measures. 13. Pelvic floor retraining by biofeedback therapy rather than laxatives is recommended for defecatory disorders. 14. When bowel symptoms are refractory to simple laxatives, newer agents should be considered in patients with NTC or STC. 15. Anorectal tests and colonic transit should be reevaluated when symptoms persist despite an adequate trial of biofeedback therapy. 16. A subtotal colectomy rather than continuing therapy with chronic laxatives should be considered for patients with symptomatic STC without a defecatory disorder. 17. Colonic intraluminal testing (manometry, barostat) should be considered to document colonic motor dysfunction before colectomy. 18. Suppositories or enemas rather than oral laxatives alone should be considered in patients with refractory pelvic floor dysfunction.

• #34 Constipation – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/constipation/diagnosis-treatment/drc-20354259

  Depending on your symptoms, your health care professional may order X-ray imaging. An X-ray can show where stool is present in the colon and if the colon is blocked. Imaging tests, such as a CT scan or MRI, may be needed to diagnose conditions that may be causing constipation. […] Your health care professional may order a test that tracks the movement of stool through the colon. This is called a colorectal transit study. […] Other tests may be used to measure how well the rectum and anus work and how well a person can pass stool. […] Surgery may be necessary to correct damage or irregularities in the tissues or nerves of the colon or rectum. Surgery is usually done only when other treatments for chronic constipation haven’t worked.

• #35 Chronic Constipation Diagnosis | Stanford Health Care

  https://stanfordhealthcare.org/medical-conditions/digestion-and-metabolic-health/chronic-constipation/diagnosis.html

  Abdominal X-ray: A standard X-ray of your small intestine to identify abnormalities or blockages […] Anorectal manometry: Measuring muscle strength in your anus with the help of a thin plastic probe we place in your rectum. This test also measures sensation and reflex activity. […] Barium enema/lower GI series: X-ray study of your rectum, large intestine, and the lower part of your small intestine using a special dye containing barium. This chemical helps show the fine details of your intestines. […] Blood tests: Using a sample of your blood, we may run a number of tests including: […] Complete blood count to look for signs of anemia and infections […] Electrolyte and kidney function panel to look for electrolyte abnormalities and liver issues […] Albumin tests to assess your nutritional status

• #36 Constipation — Risk for Alternative Diagnoses, Differential Diagnosis — Clinical Pathway: Emergency Department and Inpatient | Children’s Hospital of Philadelphia

  https://www.chop.edu/clinical-pathway/constipation-risk-alternative-diagnoses-differential-diagnosis

  The diagnosis of functional constipation is most often made through careful history and physical […] Abdominal X-ray and laboratory evaluation is not indicated […] Further Evaluation is Indicated if Concern for Alternative Diagnoses Tests should be targeted to findings by History and Physical Exam. […] Concerns for Alternative Diagnoses include delayed passage meconium after 48 hrs of life, symptom onset 1 mos, persistent abdominal distention, vomiting, bloody diarrhea, bilious emesis, family history Hirschsprungs disease, malnutrition, tight rectum gripping finger; explosive stool and air from rectum upon withdrawal examining finger, poor growth, significant weight loss, concern for abdominal mass, abnormal neurologic exam especially lower extremities, rectal exam, and lower spin abnormalities.

• #37 Chronic Constipation Diagnosis | Stanford Health Care

  https://stanfordhealthcare.org/medical-conditions/digestion-and-metabolic-health/chronic-constipation/diagnosis.html

  How Do We Diagnose Chronic Constipation? […] Stanford Health Cares comprehensive diagnostic approach includes examining your nerves, muscle control, and diet. Working together, our nutritionists and gastrointestinal motility experts conduct advanced testing both within and outside of our dedicated Gastrointestinal Motility Lab. Our goal is to rule out possible underlying conditions, such as pelvic floor dyssynergia, so we can determine the best course of treatment. […] We may perform one or more of the following tests: […] Abdominal computed tomography (CT) scan: Using X-rays and special computer software, this test creates two- and three-dimensional images of your intestines. Providing alternative views of your bowel, pancreas, and other organs, CT scans help us examine details that might not be visible through other imaging tests.

• #38 Constipation – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/constipation/diagnosis-treatment/drc-20354259

  Depending on your symptoms, your health care professional may order X-ray imaging. An X-ray can show where stool is present in the colon and if the colon is blocked. Imaging tests, such as a CT scan or MRI, may be needed to diagnose conditions that may be causing constipation. […] Your health care professional may order a test that tracks the movement of stool through the colon. This is called a colorectal transit study. […] Other tests may be used to measure how well the rectum and anus work and how well a person can pass stool. […] Surgery may be necessary to correct damage or irregularities in the tissues or nerves of the colon or rectum. Surgery is usually done only when other treatments for chronic constipation haven’t worked.

• #39 Constipation Diagnosis – Nacogdoches Gastroenterology

  https://www.nacogdochesgastroenterology.com/page-view.php?id=74

  A physical exam usually includes a rectal exam with a gloved, lubricated finger to evaluate the tone of the muscle that closes off the anuscalled the anal sphincterand to detect tenderness, obstruction, or blood. […] Additional testing is usually reserved for older adults and people with severe symptoms, sudden changes in the number and consistency of bowel movements, or blood in the stool. Additional tests that may be used to evaluate constipation include […] A blood test can show if there may be an underlying disease or condition causing constipation. For example, low levels of thyroid hormone may indicate hypothyroidism. […] A lower G.I. series is an x-ray exam that is used to look at the large intestine. […] The tests are similar, but a colonoscopy is used to view the rectum and entire colon, while a flexible sigmoidoscopy is used to view just the rectum and lower colon. […] These tests show how well food moves through the colon. […] These tests diagnose constipation caused by anorectal dysfunction, which refers to problems with the anus and rectum. […] This x-ray of the anorectal area shows how well the person can hold and evacuate stool.

• #40 Constipation – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/constipation/diagnosis-treatment/drc-20354259

  In addition to giving you a general physical exam, your health care professional will likely do the following during your appointment: […] You’ll also be asked questions about your medical history, diet, exercise habits and stools. For some people, the information from this appointment may be enough for a diagnosis and treatment plan. […] For other people, one or more additional tests may be needed to help the health care team understand the nature or cause of constipation. […] Your health care professional may send samples of your blood to a lab to test for diseases or conditions that can cause constipation. […] Your health care professional may order a procedure called an endoscopy. A small tube with a camera is guided into the colon. This can reveal the condition of the colon or the presence of irregular tissues.

• #41 Guidelines for the Diagnosis and Treatment of Chronic Functional Constipation in Korea, 2015 Revised Edition

  https://www.jnmjournal.org/journal/view.html?uid=1143&vmd=Full

  Colonoscopy should be performed to exclude conditions of secondary constipation in patients with chronic constipation if the patients have alarm symptoms, such as blood in the stool, anemia, unexplained weight loss, new-onset constipation, or a family history of colon cancer. […] Digital rectal examination is useful for the differential diagnosis of secondary constipation (rectoanal mass, rectal prolapse, and rectocele) and predicting defecatory disorders. […] Anorectal manometry is useful for diagnosing defecatory disorders in patients with constipation who fail to respond to laxatives. […] Balloon expulsion tests may be helpful in predicting defecatory disorders, but other rectoanal physiological tests should be performed to confirm the diagnosis. […] Defecography is useful for detecting anatomical abnormalities and paradoxical contraction of the pelvic floor when defecatory disorders are suspected in patients with chronic constipation.

• #42 Evaluation and management of constipation – American Gastroenterological AssociationAGA Logo_Horizontal

  https://gastro.org/clinical-guidance/evaluation-and-management-of-constipation/

  Evaluation and management of constipation. […] Recommendations for the assessment and therapeutic treatment of constipation. […] 1. If feasible, discontinue medications that can cause constipation before further testing. 2. A careful digital rectal examination that includes assessment of pelvic floor motion during simulated evacuation is preferable to a cursory examination without these maneuvers and should be performed before referral for anorectal manometry. However, a normal digital rectal examination does not exclude defecatory disorders. 3. In the absence of other symptoms and signs, only a complete blood cell count is necessary. 4. Unless other clinical features warrant otherwise, metabolic tests (glucose, calcium, sensitive thyroid-stimulating hormone) are not recommended for chronic constipation. 5. A colonoscopy should not be performed in patients without alarm features (eg, blood in stools, anemia, weight loss) unless age-appropriate colon cancer screening has not been performed. 6. Anorectal manometry and a rectal balloon expulsion should be performed in patients who fail to respond to laxatives. 7. Defecography should not be performed before anorectal manometry and a rectal balloon expulsion test. 8. Defecography should be considered when results of anorectal manometry and rectal balloon expulsion are inconclusive for defecatory disorders. 9. Colonic transit should be evaluated if anorectal test results do not show a defecatory disorder or if symptoms persist despite treatment of a defecatory disorder. 10. After discontinuing medications that can cause constipation and performing blood and other tests as guided by clinical features, a therapeutic trial (ie, fiber supplementation and/or osmotic or stimulant laxatives) is recommended before anorectal testing. 11. Normal transit constipation (NTC) and slow transit constipation (STC) can be safely managed with long-term use of laxatives. 12. Anorectal tests should be performed in patients who do not respond to these measures. 13. Pelvic floor retraining by biofeedback therapy rather than laxatives is recommended for defecatory disorders. 14. When bowel symptoms are refractory to simple laxatives, newer agents should be considered in patients with NTC or STC. 15. Anorectal tests and colonic transit should be reevaluated when symptoms persist despite an adequate trial of biofeedback therapy. 16. A subtotal colectomy rather than continuing therapy with chronic laxatives should be considered for patients with symptomatic STC without a defecatory disorder. 17. Colonic intraluminal testing (manometry, barostat) should be considered to document colonic motor dysfunction before colectomy. 18. Suppositories or enemas rather than oral laxatives alone should be considered in patients with refractory pelvic floor dysfunction.

• #43 Constipation | Conditions | UCSF Health

  https://www.ucsfhealth.org/conditions/constipation

  Your doctor will ask about your medical history, perform a physical examination and order routine blood, urine and stool tests. Other diagnostic tests used to make a diagnosis of constipation include sigmoidoscopy and colonoscopy. […] For a sigmoidoscopy, the doctor uses a special instrument called a colonoscope, which is a long, flexible tube that is about as thick as your index finger and has a tiny video camera and light on the end, to exam your rectum and lower part of your colon. […] Colonoscopy is used to evaluate symptoms such as abdominal pain, bloody bowel movements, altered bowel habits such as constipation or diarrhea, and weight loss. This test is similar to sigmoidoscopy, but the doctor looks at the entire colon, rather than just the left side. […] Your doctor will use the colonoscope to look closely for any polyps or other problems that may require evaluation, diagnosis or treatment.

• #44 Constipation Diagnosis – Nacogdoches Gastroenterology

  https://www.nacogdochesgastroenterology.com/page-view.php?id=74

  A physical exam usually includes a rectal exam with a gloved, lubricated finger to evaluate the tone of the muscle that closes off the anuscalled the anal sphincterand to detect tenderness, obstruction, or blood. […] Additional testing is usually reserved for older adults and people with severe symptoms, sudden changes in the number and consistency of bowel movements, or blood in the stool. Additional tests that may be used to evaluate constipation include […] A blood test can show if there may be an underlying disease or condition causing constipation. For example, low levels of thyroid hormone may indicate hypothyroidism. […] A lower G.I. series is an x-ray exam that is used to look at the large intestine. […] The tests are similar, but a colonoscopy is used to view the rectum and entire colon, while a flexible sigmoidoscopy is used to view just the rectum and lower colon. […] These tests show how well food moves through the colon. […] These tests diagnose constipation caused by anorectal dysfunction, which refers to problems with the anus and rectum. […] This x-ray of the anorectal area shows how well the person can hold and evacuate stool.

• #45 Evaluation and management of constipation – American Gastroenterological AssociationAGA Logo_Horizontal

  https://gastro.org/clinical-guidance/evaluation-and-management-of-constipation/

  Evaluation and management of constipation. […] Recommendations for the assessment and therapeutic treatment of constipation. […] 1. If feasible, discontinue medications that can cause constipation before further testing. 2. A careful digital rectal examination that includes assessment of pelvic floor motion during simulated evacuation is preferable to a cursory examination without these maneuvers and should be performed before referral for anorectal manometry. However, a normal digital rectal examination does not exclude defecatory disorders. 3. In the absence of other symptoms and signs, only a complete blood cell count is necessary. 4. Unless other clinical features warrant otherwise, metabolic tests (glucose, calcium, sensitive thyroid-stimulating hormone) are not recommended for chronic constipation. 5. A colonoscopy should not be performed in patients without alarm features (eg, blood in stools, anemia, weight loss) unless age-appropriate colon cancer screening has not been performed. 6. Anorectal manometry and a rectal balloon expulsion should be performed in patients who fail to respond to laxatives. 7. Defecography should not be performed before anorectal manometry and a rectal balloon expulsion test. 8. Defecography should be considered when results of anorectal manometry and rectal balloon expulsion are inconclusive for defecatory disorders. 9. Colonic transit should be evaluated if anorectal test results do not show a defecatory disorder or if symptoms persist despite treatment of a defecatory disorder. 10. After discontinuing medications that can cause constipation and performing blood and other tests as guided by clinical features, a therapeutic trial (ie, fiber supplementation and/or osmotic or stimulant laxatives) is recommended before anorectal testing. 11. Normal transit constipation (NTC) and slow transit constipation (STC) can be safely managed with long-term use of laxatives. 12. Anorectal tests should be performed in patients who do not respond to these measures. 13. Pelvic floor retraining by biofeedback therapy rather than laxatives is recommended for defecatory disorders. 14. When bowel symptoms are refractory to simple laxatives, newer agents should be considered in patients with NTC or STC. 15. Anorectal tests and colonic transit should be reevaluated when symptoms persist despite an adequate trial of biofeedback therapy. 16. A subtotal colectomy rather than continuing therapy with chronic laxatives should be considered for patients with symptomatic STC without a defecatory disorder. 17. Colonic intraluminal testing (manometry, barostat) should be considered to document colonic motor dysfunction before colectomy. 18. Suppositories or enemas rather than oral laxatives alone should be considered in patients with refractory pelvic floor dysfunction.

• #46 Diagnosis of Chronic Constipation

  https://www.kjg.or.kr/journal/view.html?pn=vol&uid=6017

  If patients with CC improve to lifestyle modification or first-line therapies, the effort to determine the subtypes of CC is usually not considered. […] On the other hand, if conventional therapeutic strategies fail, diagnostic testing needs to be considered to distinguish between the different subtypes of functional constipation (normal-transit constipation, slow transit constipation, or defecatory disorder) because these subtypes of constipation have different therapeutic implications and a correct diagnosis is critical. […] In the Seoul consensus, physiological testing is recommended for patients with functional constipation who have failed to respond to treatment with available laxatives (for a minimum of 12 weeks and recommended a therapeutic regimen) or who are strongly suspected of having a defecatory disorder. […] The Seoul consensus contains statements of physiological testing, including balloon expulsion test, anorectal manometry, defecography, and colon transit time.

• #47 Diagnosis and management of chronic constipation in adults | Nature Reviews Gastroenterology & Hepatology

  https://www.nature.com/articles/nrgastro.2016.53

  Constipation is common, impairs quality of life and consumes considerable health-care resources. […] Recognition of whether constipation is primary or secondary is key for appropriate management. […] A detailed history and physical examination including digital rectal examination is important and can identify an evacuation disorder. […] Physiological tests such as colonic transit assessment, anorectal manometry and the balloon expulsion test can facilitate stratification of patients with different constipation subtypes. […] Newer drugs, such as linaclotide and lubiprostone, laxatives, and biofeedback therapy can considerably improve symptoms in patients with chronic constipation. […] A diagnosis of primary chronic constipation is made after exclusion of secondary causes of constipation and encompasses several overlapping subtypes.

• #48 Chronic Constipation Diagnosis | Stanford Health Care

  https://stanfordhealthcare.org/medical-conditions/digestion-and-metabolic-health/chronic-constipation/diagnosis.html

  Colonic transit study (Sitz marker study): This test assesses how long it takes for food to move from your stomach through a bowel movement with a series of X-rays and a capsule with tiny rings that you swallow. […] Colonoscopy or sigmoidoscopy: Examining the entire length of your colon (screening colonoscopy) or just the lower part of your colon (sigmoidoscopy) with the help of a small flexible tube and tiny camera we insert into your rectum. […] Defecating proctogram: Recording movement in your pelvic floor muscles and rectum while you attempt to empty the contents of your rectum […] Magnetic resonance imaging (MRI) defecography: Examining all structures in your pelvic floor, rectum, and sphincter, with the help of magnetic resonance imaging, which uses radio waves and a strong magnetic field

• #49 Guidelines for the Diagnosis and Treatment of Chronic Functional Constipation in Korea, 2015 Revised Edition

  https://www.jnmjournal.org/journal/view.html?uid=1143&vmd=Full

  Colon transit time is useful for differentiating between the subtypes of defecatory disorders and slow transit constipation in patients with chronic constipation. […] A low level of physical activity is associated with chronic constipation. […] Dietary fiber can increase stool frequency in patients with chronic constipation. […] Bulking agents are effective in the treatment of chronic constipation. […] Magnesium salts improve stool frequency and consistency in patients with normal renal function. […] Nonabsorbable carbohydrates improve bowel frequency and stool consistency in patients with chronic constipation. […] Polyethylene glycol improves bowel frequency and stool consistency in patients with chronic constipation. […] Stimulant laxatives can be considered when bulk or osmotic laxatives are ineffective in improving bowel frequency and stool consistency in patients with chronic constipation.

• #50 Guidelines for the Diagnosis and Treatment of Chronic Functional Constipation in Korea, 2015 Revised Edition

  https://www.jnmjournal.org/journal/view.html?uid=1143&vmd=Full

  Colon transit time is useful for differentiating between the subtypes of defecatory disorders and slow transit constipation in patients with chronic constipation. […] A low level of physical activity is associated with chronic constipation. […] Dietary fiber can increase stool frequency in patients with chronic constipation. […] Bulking agents are effective in the treatment of chronic constipation. […] Magnesium salts improve stool frequency and consistency in patients with normal renal function. […] Nonabsorbable carbohydrates improve bowel frequency and stool consistency in patients with chronic constipation. […] Polyethylene glycol improves bowel frequency and stool consistency in patients with chronic constipation. […] Stimulant laxatives can be considered when bulk or osmotic laxatives are ineffective in improving bowel frequency and stool consistency in patients with chronic constipation.

• #51 2022 Seoul Consensus on Clinical Practice Guidelines for Functional Constipation

  https://www.jnmjournal.org/view.html?uid=1854&vmd=Full

  Anorectal manometry is useful for diagnosing defecatory disorders in patients with constipation. However, it should be performed alongside other anorectal physiological tests to confirm the diagnosis. […] Defecography is useful for assessing structural abnormality of the pelvic floor or pelvic dyssynergia in patients with chronic constipation who are suspected of having an evacuation disorder. […] Segmental colon transit time is useful for differentiating slow-transit constipation from defecatory disorder in patients with chronic constipation.

• #52 Diagnosis and management of chronic constipation in adults | Nature Reviews Gastroenterology & Hepatology

  https://www.nature.com/articles/nrgastro.2016.53

  Slow-transit constipation is characterized by prolonged colonic transit in the absence of pelvic floor dysfunction. […] This subtype of constipation can be identified using either the radio-opaque marker test or wireless motility capsule test, and is best treated with laxatives such as polyethylene glycol or newer agents such as linaclotide or lubiprostone. […] Dyssynergic defecation results from impaired coordination of rectoanal and pelvic floor muscles, and causes difficulty with defecation. […] The condition can be identified using anorectal manometry and balloon expulsion tests and is best managed with biofeedback therapy. […] Opioid-induced constipation is an emerging entity, and several drugs including naloxegol, methylnaltrexone and lubiprostone are approved for its treatment. […] In this Review, we provide an overview of the burden and pathophysiology of chronic constipation, as well as a detailed discussion of the available diagnostic tools and treatment options.

• #53 Guidelines for the Diagnosis and Treatment of Chronic Functional Constipation in Korea, 2015 Revised Edition

  https://www.jnmjournal.org/journal/view.html?uid=1143&vmd=Full

  Colonoscopy should be performed to exclude conditions of secondary constipation in patients with chronic constipation if the patients have alarm symptoms, such as blood in the stool, anemia, unexplained weight loss, new-onset constipation, or a family history of colon cancer. […] Digital rectal examination is useful for the differential diagnosis of secondary constipation (rectoanal mass, rectal prolapse, and rectocele) and predicting defecatory disorders. […] Anorectal manometry is useful for diagnosing defecatory disorders in patients with constipation who fail to respond to laxatives. […] Balloon expulsion tests may be helpful in predicting defecatory disorders, but other rectoanal physiological tests should be performed to confirm the diagnosis. […] Defecography is useful for detecting anatomical abnormalities and paradoxical contraction of the pelvic floor when defecatory disorders are suspected in patients with chronic constipation.

• #54 2022 Seoul Consensus on Clinical Practice Guidelines for Functional Constipation

  https://www.jnmjournal.org/view.html?uid=1854&vmd=Full

  Type 1 and 2 stools (according to the Bristol Stool Form Scale) can be used to predict slow-transit constipation in patients with chronic constipation. […] Digital rectal examination is useful for identifying organic anorectal causes of constipation (such as anorectal masses, rectal prolapse, and rectoceles). […] Abnormal findings on digital rectal examination, suggesting defecatory disorders, can prompt the referral for physiological tests. […] Colonoscopy should be performed in patients with constipation who have alarm symptoms or have not undergone appropriate colon cancer screening. […] Physiological tests are recommended for patients with functional constipation who have failed to respond to treatment with available laxatives (for a minimum of 12 weeks and under a recommended therapeutic regimen) or who are strongly suspected of having a defecatory disorder.

• #55 SciELO Brazil – DIAGNOSIS AND MANAGEMENT OF CHRONIC IDIOPATHIC CONSTIPATION: A NARRATIVE REVIEW FROM A BRAZILIAN EXPERT TASK FORCE DIAGNOSIS AND MANAGEMENT OF CHRONIC IDIOPATHIC CONSTIPATION: A NARRATIVE REVIEW FROM A BRAZILIAN EXPERT TASK FORCE

  https://www.scielo.br/j/ag/a/zwRh8ZSwMnsdFMJZVTHv8Dj/

  Objective measures such as stool frequency, daily stool weight (35 g/d), colonic transit, and anorectal function can also be performed and should be done while the patient is not under laxatives. […] Diagnosis of DD may be done by specific questionnaires and physical examination, and is important as it may require different treatment strategies. […] Anorectal manometry is performed in patients who fail to treatment with laxatives. The anorectal manometry assesses sphincter tone in resting and squeeze, rectoanal reflexes, rectal sensations, and changes in pressure during attempt to defecate. […] The balloon expulsion test is a screening test used to identify patients with DD, and the AGA recommendation is that this test is performed if the patient fails to laxatives. […] In case that anorectal manometry and rectal balloon expulsion tests are inconclusive, the AGA recommends the defecography is performed.

• #56 Guidelines for the Diagnosis and Treatment of Chronic Functional Constipation in Korea, 2015 Revised Edition

  https://www.jnmjournal.org/journal/view.html?uid=1143&vmd=Full

  Colonoscopy should be performed to exclude conditions of secondary constipation in patients with chronic constipation if the patients have alarm symptoms, such as blood in the stool, anemia, unexplained weight loss, new-onset constipation, or a family history of colon cancer. […] Digital rectal examination is useful for the differential diagnosis of secondary constipation (rectoanal mass, rectal prolapse, and rectocele) and predicting defecatory disorders. […] Anorectal manometry is useful for diagnosing defecatory disorders in patients with constipation who fail to respond to laxatives. […] Balloon expulsion tests may be helpful in predicting defecatory disorders, but other rectoanal physiological tests should be performed to confirm the diagnosis. […] Defecography is useful for detecting anatomical abnormalities and paradoxical contraction of the pelvic floor when defecatory disorders are suspected in patients with chronic constipation.

• #57 2022 Seoul Consensus on Clinical Practice Guidelines for Functional Constipation

  https://www.jnmjournal.org/view.html?uid=1854&vmd=Full

  Anorectal manometry is useful for diagnosing defecatory disorders in patients with constipation. However, it should be performed alongside other anorectal physiological tests to confirm the diagnosis. […] Defecography is useful for assessing structural abnormality of the pelvic floor or pelvic dyssynergia in patients with chronic constipation who are suspected of having an evacuation disorder. […] Segmental colon transit time is useful for differentiating slow-transit constipation from defecatory disorder in patients with chronic constipation.

• #58 Chronic Constipation Diagnosis | Stanford Health Care

  https://stanfordhealthcare.org/medical-conditions/digestion-and-metabolic-health/chronic-constipation/diagnosis.html

  Colonic transit study (Sitz marker study): This test assesses how long it takes for food to move from your stomach through a bowel movement with a series of X-rays and a capsule with tiny rings that you swallow. […] Colonoscopy or sigmoidoscopy: Examining the entire length of your colon (screening colonoscopy) or just the lower part of your colon (sigmoidoscopy) with the help of a small flexible tube and tiny camera we insert into your rectum. […] Defecating proctogram: Recording movement in your pelvic floor muscles and rectum while you attempt to empty the contents of your rectum […] Magnetic resonance imaging (MRI) defecography: Examining all structures in your pelvic floor, rectum, and sphincter, with the help of magnetic resonance imaging, which uses radio waves and a strong magnetic field

• #59 Chronic Constipation Diagnosis | Stanford Health Care

  https://stanfordhealthcare.org/medical-conditions/digestion-and-metabolic-health/chronic-constipation/diagnosis.html

  Wireless capsule gastrointestinal monitoring system: Swallowing a pill with a tiny wireless monitoring system inside (SmartPill) to record acid levels, temperature, and pressure changes in your GI tract. The wireless motility test lets us know how fast or slow your stomach, small bowel, and colon are emptying. Your body cannot digest the SmartPill, and it will eventually pass through a bowel movement.

• #60 Evaluation and management of constipation – American Gastroenterological AssociationAGA Logo_Horizontal

  https://gastro.org/clinical-guidance/evaluation-and-management-of-constipation/

  Evaluation and management of constipation. […] Recommendations for the assessment and therapeutic treatment of constipation. […] 1. If feasible, discontinue medications that can cause constipation before further testing. 2. A careful digital rectal examination that includes assessment of pelvic floor motion during simulated evacuation is preferable to a cursory examination without these maneuvers and should be performed before referral for anorectal manometry. However, a normal digital rectal examination does not exclude defecatory disorders. 3. In the absence of other symptoms and signs, only a complete blood cell count is necessary. 4. Unless other clinical features warrant otherwise, metabolic tests (glucose, calcium, sensitive thyroid-stimulating hormone) are not recommended for chronic constipation. 5. A colonoscopy should not be performed in patients without alarm features (eg, blood in stools, anemia, weight loss) unless age-appropriate colon cancer screening has not been performed. 6. Anorectal manometry and a rectal balloon expulsion should be performed in patients who fail to respond to laxatives. 7. Defecography should not be performed before anorectal manometry and a rectal balloon expulsion test. 8. Defecography should be considered when results of anorectal manometry and rectal balloon expulsion are inconclusive for defecatory disorders. 9. Colonic transit should be evaluated if anorectal test results do not show a defecatory disorder or if symptoms persist despite treatment of a defecatory disorder. 10. After discontinuing medications that can cause constipation and performing blood and other tests as guided by clinical features, a therapeutic trial (ie, fiber supplementation and/or osmotic or stimulant laxatives) is recommended before anorectal testing. 11. Normal transit constipation (NTC) and slow transit constipation (STC) can be safely managed with long-term use of laxatives. 12. Anorectal tests should be performed in patients who do not respond to these measures. 13. Pelvic floor retraining by biofeedback therapy rather than laxatives is recommended for defecatory disorders. 14. When bowel symptoms are refractory to simple laxatives, newer agents should be considered in patients with NTC or STC. 15. Anorectal tests and colonic transit should be reevaluated when symptoms persist despite an adequate trial of biofeedback therapy. 16. A subtotal colectomy rather than continuing therapy with chronic laxatives should be considered for patients with symptomatic STC without a defecatory disorder. 17. Colonic intraluminal testing (manometry, barostat) should be considered to document colonic motor dysfunction before colectomy. 18. Suppositories or enemas rather than oral laxatives alone should be considered in patients with refractory pelvic floor dysfunction.

• #61 Evaluation of Constipation | AAFP

  https://www.aafp.org/pubs/afp/issues/2002/0601/p2283.html

  If extracolonic and mechanical causes of constipation are excluded by laboratory studies and colorectal imaging, a complete physiologic evaluation is warranted. […] A suggested approach to the evaluation and management of constipation in adults is provided in Figure 1. […] In children with constipation, the initial history and physical examination usually reveal no other problems. […] In the absence of red flags, no testing or subspecialist consultation is needed before treatment is initiated. […] Fecal occult blood testing is recommended in all infants with constipation, and in children of any age who have abdominal pain, failure to thrive, intermittent diarrhea, or a family history of colon cancer or colonic polyps. […] Anorectal manometry is indicated to demonstrate the rectoanal inhibitory reflex and to rule out Hirschsprung’s disease.

• #62 Diagnosis and management of chronic constipation in adults | Nature Reviews Gastroenterology & Hepatology

  https://www.nature.com/articles/nrgastro.2016.53

  Slow-transit constipation is characterized by prolonged colonic transit in the absence of pelvic floor dysfunction. […] This subtype of constipation can be identified using either the radio-opaque marker test or wireless motility capsule test, and is best treated with laxatives such as polyethylene glycol or newer agents such as linaclotide or lubiprostone. […] Dyssynergic defecation results from impaired coordination of rectoanal and pelvic floor muscles, and causes difficulty with defecation. […] The condition can be identified using anorectal manometry and balloon expulsion tests and is best managed with biofeedback therapy. […] Opioid-induced constipation is an emerging entity, and several drugs including naloxegol, methylnaltrexone and lubiprostone are approved for its treatment. […] In this Review, we provide an overview of the burden and pathophysiology of chronic constipation, as well as a detailed discussion of the available diagnostic tools and treatment options.

• #63 Management of persistent unresponsive constipation in adults – UpToDate

  https://www.uptodate.com/contents/management-of-persistent-unresponsive-constipation-in-adults

  Chronic idiopathic constipation may be associated with defecatory dysfunction (pelvic floor dysfunction), slow colonic transit, or both. Most patients with chronic idiopathic constipation improve with lifestyle modification, fiber supplementation, and traditional stimulant and osmotic laxative therapy. Patients who experience persistent symptoms despite an adequate trial (usually at least one month or more) of these initial measures warrant additional testing and/or therapy. […] This topic will review the management of chronic constipation that is nonresponsive to initial management. The approach to diagnosis and initial management of constipation in adults, as well as management of opioid-related constipation and irritable bowel syndrome with predominant constipation, are presented separately.

• #64 2022 Seoul Consensus on Clinical Practice Guidelines for Functional Constipation

  https://www.jnmjournal.org/view.html?uid=1854&vmd=Full

  Constipation manifests as a variety of symptoms, such as infrequent bowel movements, hard stools, feeling of incomplete evacuation, straining at defecation, a sense of anorectal blockage during defecation, and use of digital maneuvers to assist defecation. […] During the diagnosis of chronic constipation, the Bristol Stool Form Scale, colonoscopy, and a digital rectal examination are useful for objective symptom evaluation and differential diagnosis of secondary constipation. […] Physiological tests for functional constipation have complementary roles and are recommended for patients who have failed to respond to treatment with available laxatives and those who are strongly suspected of having a defecatory disorder. […] The guidelines consist of 34 recommendations, including 3 concerning the definition and epidemiology of functional constipation, 9 regarding diagnoses, and 22 regarding managements.

• #65 Constipation Differential Diagnoses

  https://emedicine.medscape.com/article/184704-differential

  It is important to be vigilant for colorectal cancer. Anal fissure should be considered in a constipated child. Colonic ileus secondary to sepsis or an intra-abdominal catastrophe may be misdiagnosed as constipation; large bowel obstruction may also be misdiagnosed as constipation. […] In addition to the conditions listed in the differential diagnosis, the following problems should be considered: Psychological causes, Diabetes mellitus, Hyperparathyroidism, Hypothyroidism, Uremia, Lead poisoning, Neuropathy, Parkinson disease, Multiple sclerosis, Spinal cord injuries, Scleroderma, Lupus, Amyloidosis. […] Differential Diagnoses: Abdominal Hernias, Anxiety Disorders, Appendicitis, Chagas Disease (American Trypanosomiasis), Colon Cancer, Colonic Obstruction, Crohn Disease, Depression, Diverticulitis, Hypopituitarism (Panhypopituitarism), Hypothyroidism, Ileus, Intestinal Motility Disorders, Irritable Bowel Syndrome (IBS), Large-Bowel Obstruction, Ogilvie Syndrome, Peritonitis and Abdominal Sepsis, Toxic Megacolon, Multiple Endocrine Neoplasia Type 2 (MEN2).

• #66 Constipation — Risk for Alternative Diagnoses, Differential Diagnosis — Clinical Pathway: Emergency Department and Inpatient | Children’s Hospital of Philadelphia

  https://www.chop.edu/clinical-pathway/constipation-risk-alternative-diagnoses-differential-diagnosis

  Differential Diagnosis of Constipation includes functional constipation, cows milk allergy, Crohns disease, celiac disease, malnutrition, starvation, poor fluid intake, motility disorders such as Hirschsprung disease and congenital pseudo-obstruction, neurologic issues like infant botulism and spinal cord abnormality, endocrine disorders such as thyroid disorders, toxins like lead, and medications known to cause constipation including antidepressants, antipsychotics, iron, loperamide, anticholinergics, and antihistamines.

• #67 Diagnosis and management of chronic constipation in adults | Nature Reviews Gastroenterology & Hepatology

  https://www.nature.com/articles/nrgastro.2016.53

  Constipation is common, impairs quality of life and consumes considerable health-care resources. […] Recognition of whether constipation is primary or secondary is key for appropriate management. […] A detailed history and physical examination including digital rectal examination is important and can identify an evacuation disorder. […] Physiological tests such as colonic transit assessment, anorectal manometry and the balloon expulsion test can facilitate stratification of patients with different constipation subtypes. […] Newer drugs, such as linaclotide and lubiprostone, laxatives, and biofeedback therapy can considerably improve symptoms in patients with chronic constipation. […] A diagnosis of primary chronic constipation is made after exclusion of secondary causes of constipation and encompasses several overlapping subtypes.

• #68 Guidelines for the Diagnosis and Treatment of Chronic Functional Constipation in Korea, 2015 Revised Edition

  https://www.jnmjournal.org/journal/view.html?uid=1143&vmd=Full

  Chronic constipation is defined as the occurrence of bowel symptoms of infrequent bowel movements, hard stool, feeling of incomplete evacuation, straining at defecation, a sense of anorectal blockage during defecation, and use of digital maneuvers to assist defecation. […] Functional constipation is classified into three categories: defecatory disorders, slow transit constipation, and normal transit constipation. […] The physician should recommend discontinuing drugs that can cause constipation, if appropriate. […] The prevalence of constipation in elderly populations increases because of multifactorial causes with co-morbid diseases, impaired mobility, reduced dietary fiber intake, and drugs contributing to constipation. […] Stool form may be helpful in predicting colon transit time.

• #69 Diagnosis and management of chronic constipation in adults | Nature Reviews Gastroenterology & Hepatology

  https://www.nature.com/articles/nrgastro.2016.53

  Slow-transit constipation is characterized by prolonged colonic transit in the absence of pelvic floor dysfunction. […] This subtype of constipation can be identified using either the radio-opaque marker test or wireless motility capsule test, and is best treated with laxatives such as polyethylene glycol or newer agents such as linaclotide or lubiprostone. […] Dyssynergic defecation results from impaired coordination of rectoanal and pelvic floor muscles, and causes difficulty with defecation. […] The condition can be identified using anorectal manometry and balloon expulsion tests and is best managed with biofeedback therapy. […] Opioid-induced constipation is an emerging entity, and several drugs including naloxegol, methylnaltrexone and lubiprostone are approved for its treatment. […] In this Review, we provide an overview of the burden and pathophysiology of chronic constipation, as well as a detailed discussion of the available diagnostic tools and treatment options.

• #70 Diagnosis and management of chronic constipation in adults | Nature Reviews Gastroenterology & Hepatology

  https://www.nature.com/articles/nrgastro.2016.53

  Slow-transit constipation is characterized by prolonged colonic transit in the absence of pelvic floor dysfunction. […] This subtype of constipation can be identified using either the radio-opaque marker test or wireless motility capsule test, and is best treated with laxatives such as polyethylene glycol or newer agents such as linaclotide or lubiprostone. […] Dyssynergic defecation results from impaired coordination of rectoanal and pelvic floor muscles, and causes difficulty with defecation. […] The condition can be identified using anorectal manometry and balloon expulsion tests and is best managed with biofeedback therapy. […] Opioid-induced constipation is an emerging entity, and several drugs including naloxegol, methylnaltrexone and lubiprostone are approved for its treatment. […] In this Review, we provide an overview of the burden and pathophysiology of chronic constipation, as well as a detailed discussion of the available diagnostic tools and treatment options.

• #71 Slow transit constipation | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/slow-transit-constipation

  Slow transit constipation is characterised by the reduced motility of the large intestine, caused by abnormalities of the enteric nerves. […] Diagnosis of slow transit constipation […] A more specialised diagnosis or confirmation of STC should involve one or more of: comprehensive assessment by a specialist continence adviser, colonic nuclear transit study (NTS), full thickness laparoscopic biopsy. […] Treatment for slow transit constipation […] Treatment options may include medication to improve bowel motility, regular enemas to flush the rectum of faeces, interferential electrical stimulation therapy. […] There is no cure for slow transit constipation.

• #72 Diagnosis and management of chronic constipation in adults | Nature Reviews Gastroenterology & Hepatology

  https://www.nature.com/articles/nrgastro.2016.53

  Slow-transit constipation is characterized by prolonged colonic transit in the absence of pelvic floor dysfunction. […] This subtype of constipation can be identified using either the radio-opaque marker test or wireless motility capsule test, and is best treated with laxatives such as polyethylene glycol or newer agents such as linaclotide or lubiprostone. […] Dyssynergic defecation results from impaired coordination of rectoanal and pelvic floor muscles, and causes difficulty with defecation. […] The condition can be identified using anorectal manometry and balloon expulsion tests and is best managed with biofeedback therapy. […] Opioid-induced constipation is an emerging entity, and several drugs including naloxegol, methylnaltrexone and lubiprostone are approved for its treatment. […] In this Review, we provide an overview of the burden and pathophysiology of chronic constipation, as well as a detailed discussion of the available diagnostic tools and treatment options.

• #73 Diagnosis and Treatment of Chronic Constipation

  https://www.jstage.jst.go.jp/article/jcoloproctology/72/10/72_583/_article/-char/en

  If the initial therapy for chronic constipation fails, its pathophysiology should be diagnosed with a colonic transit study and defecography at specialized institutions, where centrally mediated abdominal pain syndrome, functional abdominal bloating/distension and obsessive-compulsive disorder of defecation should be excluded from true chronic constipation. […] Specialized therapies include biofeedback therapy, transanal irrigation, rectocele repair, ventral rectopexy, and total colectomy with ileorectal anastomosis.

• #74 Diagnosis, Treatment, and Management of Irritable Bowel Syndrome With Constipation and Chronic Constipation

  https://www.medscape.org/viewarticle/509930_3

  There is no single definition of constipation, and even in the medical literature the experts’ definitions and categories of constipation are inconsistent. […] Diagnostic criteria for functional constipation do exist, as noted above, and include parameters, such as stool frequency, stool quality (consistency, sensation of incomplete evacuation or anorectal blockage, or both), and straining. […] Constipation can be caused by primary and secondary factors. […] One important point to remember is that not all patients will necessarily be categorized as having one type of primary constipation. […] Secondary causes are abundant and need to be considered in any patient with constipation. […] Although distinct diagnostic criteria exist for each disorder, differentiating the disorders is more a question of semantics than clinical relevance, because the treatment plans for patients with IBS-C and chronic constipation are similar.

• #75 SciELO Brazil – DIAGNOSIS AND MANAGEMENT OF CHRONIC IDIOPATHIC CONSTIPATION: A NARRATIVE REVIEW FROM A BRAZILIAN EXPERT TASK FORCE DIAGNOSIS AND MANAGEMENT OF CHRONIC IDIOPATHIC CONSTIPATION: A NARRATIVE REVIEW FROM A BRAZILIAN EXPERT TASK FORCE

  https://www.scielo.br/j/ag/a/zwRh8ZSwMnsdFMJZVTHv8Dj/

  Chronic idiopathic constipation (CIC) is a condition that widely affects the global population, represents relevant healthcare resource utilization and costs, and impacts the individuals well-being. […] To review the consensus of expert societies and published guidelines on the diagnosis and treatment of CIC in adults, seeking to assist reasoning and decision-making for medical management of patients with CIC and provide a practical reference material. […] The diagnostic approach and the understanding of the pathophysiology present in CIC are essential items to indicate the appropriate therapy and to understand the ecosystem of the patients needs. […] CIC is a common condition in adults, occurring more frequently in the elderly and in women. Proper management is defined by detailed medical history and physical examination, together with appropriate therapeutics, regardless pharmacological or not, and depending on the best moment of indication. This way, the impact on quality of life is also optimized.

• #76 Diagnosis and Treatment of Chronic Constipation

  https://www.jstage.jst.go.jp/article/jcoloproctology/72/10/72_583/_article/-char/en

  Constipation is defined as a chronic condition, in which a certain amount of stool that ought to be defecated cannot be evacuated sufficiently and comfortably in the Japanese Guideline for the Management of Chronic Constipation published in 2017. […] Chronic constipation is classified into infrequent bowel motion type (IBM) and evacuation difficulty type (ED) depending on its symptoms, and is further classified into slow transit constipation, normal transit constipation and defecation disorder depending on its pathophysiology. […] There are many causes of chronic constipation and so it should be adequately treated based on a proper diagnosis of its causes. […] The initial management of patients with chronic constipation includes differential diagnosis of IBM and ED based on their symptoms and physical findings, followed by modification of diet, lifestyle and bowel habits and medical therapy with drugs.

• #77 Evaluation and management of constipation – American Gastroenterological AssociationAGA Logo_Horizontal

  https://gastro.org/clinical-guidance/evaluation-and-management-of-constipation/

  Evaluation and management of constipation. […] Recommendations for the assessment and therapeutic treatment of constipation. […] 1. If feasible, discontinue medications that can cause constipation before further testing. 2. A careful digital rectal examination that includes assessment of pelvic floor motion during simulated evacuation is preferable to a cursory examination without these maneuvers and should be performed before referral for anorectal manometry. However, a normal digital rectal examination does not exclude defecatory disorders. 3. In the absence of other symptoms and signs, only a complete blood cell count is necessary. 4. Unless other clinical features warrant otherwise, metabolic tests (glucose, calcium, sensitive thyroid-stimulating hormone) are not recommended for chronic constipation. 5. A colonoscopy should not be performed in patients without alarm features (eg, blood in stools, anemia, weight loss) unless age-appropriate colon cancer screening has not been performed. 6. Anorectal manometry and a rectal balloon expulsion should be performed in patients who fail to respond to laxatives. 7. Defecography should not be performed before anorectal manometry and a rectal balloon expulsion test. 8. Defecography should be considered when results of anorectal manometry and rectal balloon expulsion are inconclusive for defecatory disorders. 9. Colonic transit should be evaluated if anorectal test results do not show a defecatory disorder or if symptoms persist despite treatment of a defecatory disorder. 10. After discontinuing medications that can cause constipation and performing blood and other tests as guided by clinical features, a therapeutic trial (ie, fiber supplementation and/or osmotic or stimulant laxatives) is recommended before anorectal testing. 11. Normal transit constipation (NTC) and slow transit constipation (STC) can be safely managed with long-term use of laxatives. 12. Anorectal tests should be performed in patients who do not respond to these measures. 13. Pelvic floor retraining by biofeedback therapy rather than laxatives is recommended for defecatory disorders. 14. When bowel symptoms are refractory to simple laxatives, newer agents should be considered in patients with NTC or STC. 15. Anorectal tests and colonic transit should be reevaluated when symptoms persist despite an adequate trial of biofeedback therapy. 16. A subtotal colectomy rather than continuing therapy with chronic laxatives should be considered for patients with symptomatic STC without a defecatory disorder. 17. Colonic intraluminal testing (manometry, barostat) should be considered to document colonic motor dysfunction before colectomy. 18. Suppositories or enemas rather than oral laxatives alone should be considered in patients with refractory pelvic floor dysfunction.

• #78 Evaluation and management of constipation – American Gastroenterological AssociationAGA Logo_Horizontal

  https://gastro.org/clinical-guidance/evaluation-and-management-of-constipation/

  Evaluation and management of constipation. […] Recommendations for the assessment and therapeutic treatment of constipation. […] 1. If feasible, discontinue medications that can cause constipation before further testing. 2. A careful digital rectal examination that includes assessment of pelvic floor motion during simulated evacuation is preferable to a cursory examination without these maneuvers and should be performed before referral for anorectal manometry. However, a normal digital rectal examination does not exclude defecatory disorders. 3. In the absence of other symptoms and signs, only a complete blood cell count is necessary. 4. Unless other clinical features warrant otherwise, metabolic tests (glucose, calcium, sensitive thyroid-stimulating hormone) are not recommended for chronic constipation. 5. A colonoscopy should not be performed in patients without alarm features (eg, blood in stools, anemia, weight loss) unless age-appropriate colon cancer screening has not been performed. 6. Anorectal manometry and a rectal balloon expulsion should be performed in patients who fail to respond to laxatives. 7. Defecography should not be performed before anorectal manometry and a rectal balloon expulsion test. 8. Defecography should be considered when results of anorectal manometry and rectal balloon expulsion are inconclusive for defecatory disorders. 9. Colonic transit should be evaluated if anorectal test results do not show a defecatory disorder or if symptoms persist despite treatment of a defecatory disorder. 10. After discontinuing medications that can cause constipation and performing blood and other tests as guided by clinical features, a therapeutic trial (ie, fiber supplementation and/or osmotic or stimulant laxatives) is recommended before anorectal testing. 11. Normal transit constipation (NTC) and slow transit constipation (STC) can be safely managed with long-term use of laxatives. 12. Anorectal tests should be performed in patients who do not respond to these measures. 13. Pelvic floor retraining by biofeedback therapy rather than laxatives is recommended for defecatory disorders. 14. When bowel symptoms are refractory to simple laxatives, newer agents should be considered in patients with NTC or STC. 15. Anorectal tests and colonic transit should be reevaluated when symptoms persist despite an adequate trial of biofeedback therapy. 16. A subtotal colectomy rather than continuing therapy with chronic laxatives should be considered for patients with symptomatic STC without a defecatory disorder. 17. Colonic intraluminal testing (manometry, barostat) should be considered to document colonic motor dysfunction before colectomy. 18. Suppositories or enemas rather than oral laxatives alone should be considered in patients with refractory pelvic floor dysfunction.

• #79 Evaluation and management of constipation – American Gastroenterological AssociationAGA Logo_Horizontal

  https://gastro.org/clinical-guidance/evaluation-and-management-of-constipation/

  Evaluation and management of constipation. […] Recommendations for the assessment and therapeutic treatment of constipation. […] 1. If feasible, discontinue medications that can cause constipation before further testing. 2. A careful digital rectal examination that includes assessment of pelvic floor motion during simulated evacuation is preferable to a cursory examination without these maneuvers and should be performed before referral for anorectal manometry. However, a normal digital rectal examination does not exclude defecatory disorders. 3. In the absence of other symptoms and signs, only a complete blood cell count is necessary. 4. Unless other clinical features warrant otherwise, metabolic tests (glucose, calcium, sensitive thyroid-stimulating hormone) are not recommended for chronic constipation. 5. A colonoscopy should not be performed in patients without alarm features (eg, blood in stools, anemia, weight loss) unless age-appropriate colon cancer screening has not been performed. 6. Anorectal manometry and a rectal balloon expulsion should be performed in patients who fail to respond to laxatives. 7. Defecography should not be performed before anorectal manometry and a rectal balloon expulsion test. 8. Defecography should be considered when results of anorectal manometry and rectal balloon expulsion are inconclusive for defecatory disorders. 9. Colonic transit should be evaluated if anorectal test results do not show a defecatory disorder or if symptoms persist despite treatment of a defecatory disorder. 10. After discontinuing medications that can cause constipation and performing blood and other tests as guided by clinical features, a therapeutic trial (ie, fiber supplementation and/or osmotic or stimulant laxatives) is recommended before anorectal testing. 11. Normal transit constipation (NTC) and slow transit constipation (STC) can be safely managed with long-term use of laxatives. 12. Anorectal tests should be performed in patients who do not respond to these measures. 13. Pelvic floor retraining by biofeedback therapy rather than laxatives is recommended for defecatory disorders. 14. When bowel symptoms are refractory to simple laxatives, newer agents should be considered in patients with NTC or STC. 15. Anorectal tests and colonic transit should be reevaluated when symptoms persist despite an adequate trial of biofeedback therapy. 16. A subtotal colectomy rather than continuing therapy with chronic laxatives should be considered for patients with symptomatic STC without a defecatory disorder. 17. Colonic intraluminal testing (manometry, barostat) should be considered to document colonic motor dysfunction before colectomy. 18. Suppositories or enemas rather than oral laxatives alone should be considered in patients with refractory pelvic floor dysfunction.

• #80 Constipation – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK513291/

  Constipation, a common gastrointestinal ailment, is a condition that affects individuals of all ages, from newborns to older individuals, transcending gender, race, and socioeconomic backgrounds. Characterized by infrequent and often difficult bowel movements, constipation is more than just a symptom. It can significantly impact an individual’s quality of life and, if left unmanaged, may lead to various health complications. Constipation contributes substantially to healthcare use in the United States and globally. The condition encompasses various subtypes, including functional constipation, chronic idiopathic constipation, and secondary constipation, each with distinct underlying factors and clinical features. […] It is essential to understand the clinical evaluation of a patient with constipation. This activity reviews the multifaceted nature of constipation, shedding light on its causes, symptoms, prevalence, and the importance of effective management for maintaining overall well-being. It also emphasizes the critical role of the interprofessional team in coordinating the care of the patient with constipation.

• #81 Chronic constipation diagnosis and treatment evaluation: the “CHRO.CO.DI.T.E.” study | BMC Gastroenterology | Full Text

  https://bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-016-0556-7

  According to Rome criteria, chronic constipation (CC) includes functional constipation (FC) and irritable bowel syndrome with constipation (IBS-C). The aim of the study was is to evaluate the various clinical presentation and management of FC, IBS-C and NRC in Italy. […] Diagnostic tests and prescribed therapies were also recorded. […] Digital rectal examination was performed in only 56.4%. Diagnostic tests were prescribed to 80.0%. […] Colonoscopy and blood tests were the first line diagnostic tools. […] Diagnostic tests and prescribed therapies increased by increasing CC severity. […] Patients with IBS-C reported more severe symptoms and worse quality of life than FC and NRC. […] At least a specialist consultation was requested in 277/878 (31.6%) patients, mostly psychiatric/psychological, urological and gynecological. […] Diagnostic tests were requested in 702/878 (80.0%) of the patients. […] Macrogol was suggested more frequently in FC and IBS-C than in NRC. […] This study can provide several educational ideas to improve the diagnostic and therapeutic approach to Chronic Constipation.

• #82 Chronic constipation diagnosis and treatment evaluation: the “CHRO.CO.DI.T.E.” study | BMC Gastroenterology | Full Text

  https://bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-016-0556-7

  According to Rome criteria, chronic constipation (CC) includes functional constipation (FC) and irritable bowel syndrome with constipation (IBS-C). The aim of the study was is to evaluate the various clinical presentation and management of FC, IBS-C and NRC in Italy. […] Diagnostic tests and prescribed therapies were also recorded. […] Digital rectal examination was performed in only 56.4%. Diagnostic tests were prescribed to 80.0%. […] Colonoscopy and blood tests were the first line diagnostic tools. […] Diagnostic tests and prescribed therapies increased by increasing CC severity. […] Patients with IBS-C reported more severe symptoms and worse quality of life than FC and NRC. […] At least a specialist consultation was requested in 277/878 (31.6%) patients, mostly psychiatric/psychological, urological and gynecological. […] Diagnostic tests were requested in 702/878 (80.0%) of the patients. […] Macrogol was suggested more frequently in FC and IBS-C than in NRC. […] This study can provide several educational ideas to improve the diagnostic and therapeutic approach to Chronic Constipation.

• #83 Diagnostic Approach to Chronic Constipation in Adults | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/0801/p299.html

  If the patient has symptoms of outlet constipation or has not responded to reasonable laxative therapy, testing for pelvic floor dysfunction is warranted. […] After ruling out secondary causes of constipation and determining that diagnostic testing is unnecessary, the physician should encourage lifestyle modification, which includes a high-fiber diet, exercise, and increased water intake.

• #84 Diagnosis and management of chronic constipation in adults | Nature Reviews Gastroenterology & Hepatology

  https://www.nature.com/articles/nrgastro.2016.53

  Constipation is common, impairs quality of life and consumes considerable health-care resources. […] Recognition of whether constipation is primary or secondary is key for appropriate management. […] A detailed history and physical examination including digital rectal examination is important and can identify an evacuation disorder. […] Physiological tests such as colonic transit assessment, anorectal manometry and the balloon expulsion test can facilitate stratification of patients with different constipation subtypes. […] Newer drugs, such as linaclotide and lubiprostone, laxatives, and biofeedback therapy can considerably improve symptoms in patients with chronic constipation. […] A diagnosis of primary chronic constipation is made after exclusion of secondary causes of constipation and encompasses several overlapping subtypes.

• #85 Diagnosis of Chronic Constipation

  https://www.kjg.or.kr/journal/view.html?pn=vol&uid=6017

  If patients with CC improve to lifestyle modification or first-line therapies, the effort to determine the subtypes of CC is usually not considered. […] On the other hand, if conventional therapeutic strategies fail, diagnostic testing needs to be considered to distinguish between the different subtypes of functional constipation (normal-transit constipation, slow transit constipation, or defecatory disorder) because these subtypes of constipation have different therapeutic implications and a correct diagnosis is critical. […] In the Seoul consensus, physiological testing is recommended for patients with functional constipation who have failed to respond to treatment with available laxatives (for a minimum of 12 weeks and recommended a therapeutic regimen) or who are strongly suspected of having a defecatory disorder. […] The Seoul consensus contains statements of physiological testing, including balloon expulsion test, anorectal manometry, defecography, and colon transit time.

• #86 SciELO Brazil – DIAGNOSIS AND MANAGEMENT OF CHRONIC IDIOPATHIC CONSTIPATION: A NARRATIVE REVIEW FROM A BRAZILIAN EXPERT TASK FORCE DIAGNOSIS AND MANAGEMENT OF CHRONIC IDIOPATHIC CONSTIPATION: A NARRATIVE REVIEW FROM A BRAZILIAN EXPERT TASK FORCE

  https://www.scielo.br/j/ag/a/zwRh8ZSwMnsdFMJZVTHv8Dj/

  Chronic idiopathic constipation (CIC) is a condition that widely affects the global population, represents relevant healthcare resource utilization and costs, and impacts the individuals well-being. […] To review the consensus of expert societies and published guidelines on the diagnosis and treatment of CIC in adults, seeking to assist reasoning and decision-making for medical management of patients with CIC and provide a practical reference material. […] The diagnostic approach and the understanding of the pathophysiology present in CIC are essential items to indicate the appropriate therapy and to understand the ecosystem of the patients needs. […] CIC is a common condition in adults, occurring more frequently in the elderly and in women. Proper management is defined by detailed medical history and physical examination, together with appropriate therapeutics, regardless pharmacological or not, and depending on the best moment of indication. This way, the impact on quality of life is also optimized.

• #87 Constipation – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK513291/

  Constipation, a common gastrointestinal ailment, is a condition that affects individuals of all ages, from newborns to older individuals, transcending gender, race, and socioeconomic backgrounds. Characterized by infrequent and often difficult bowel movements, constipation is more than just a symptom. It can significantly impact an individual’s quality of life and, if left unmanaged, may lead to various health complications. Constipation contributes substantially to healthcare use in the United States and globally. The condition encompasses various subtypes, including functional constipation, chronic idiopathic constipation, and secondary constipation, each with distinct underlying factors and clinical features. […] It is essential to understand the clinical evaluation of a patient with constipation. This activity reviews the multifaceted nature of constipation, shedding light on its causes, symptoms, prevalence, and the importance of effective management for maintaining overall well-being. It also emphasizes the critical role of the interprofessional team in coordinating the care of the patient with constipation.

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