Constipation
Key Points
Key Points
Figure 1A. Bristol Stool Form Scale
Figure 1B. IBS Subtypes and Stool Form
Table 1. Symptom Criteria for Constipationa
| Irritable Bowel Syndrome (IBS) |
|---|
| Criteria fulfilled for the last 3 months with symptom onset ≥6 months prior to diagnosis. |
Recurrent abdominal pain, on average, ≥1 day per week in the last 3 months, associated with ≥2 of the following criteria:
|
| IBS with predominant constipation (IBS-C): |
| More than one-fourth (25%) of bowel movements with Bristol stool form types 1 or 2 and less than one-fourth (25%) of bowel movements with Bristol stool form types 6 or 7. |
| Alternative for epidemiology or clinical practice: Patient reports that abnormal bowel movements are usually constipation (like type 1 or 2 in the picture of Bristol Stool Form Scale (BSFS), see Figure 1A). |
| Functional Constipation (FC)b |
| FC is a functional bowel disorder in which symptoms of difficult, infrequent, or incomplete defecation predominate. Patients with FC should not meet IBS criteria. Although abdominal pain and/or bloating may be present, they are not predominant symptoms. Symptom onset should occur ≥6 months before diagnosis, and symptoms should be present during the last 3 months. |
| General Definition of Constipation |
|
| Defecatory disorders |
Prolonged and excessive straining before elimination
|
| Need for perineal or vaginal pressure to allow stools to be passed or direct digital evacuation of stools |
| Diagnosis requires anorectal tests (manometry, rectal balloon expulsion, or defecography [barium or MRI]) suggestive of a defecatory disorder |
| Normal transit constipation (NTC) |
| Normal colonic transit and anorectal functions |
| Slow transit constipation (STC) |
| Slow colonic transit and normal anorectal functions |
| Combination Disorders |
| Some patients may have combination or overlap disorders (eg, STC with defecatory disorders), perhaps even associated with features of irritable bowel syndrome. |
b For research studies, patients meeting criteria for OIC should not be given a diagnosis of FC because it is difficult to distinguish between opioid side effects and other causes of constipation. However, clinicians recognize that these 2 conditions might overlap.
Figure 2. Conceptual Framework to Explain FBDs
Assessment
...sessment...
...If feasible, discontinue medications that can caus...
...ul digital rectal examination that includes...
...ts of the rectal examination include: I...
...for Medical Causes...
...ence of other symptoms and signs, only a complet...
...her clinical features warrant otherwise, metabolic...
...should not be performed in patients wit...
...norectal manometry and a rectal balloon ex...
...should not be performed before anorectal m...
...uld be considered when results of anorectal...
...should be evaluated if anorectal test resul...
Treatment
Treatm...
...tinuing medications that can cause constipati...
...sts should be performed in patients...
...elvic floor retraining by biofeedback therap...
Surgical Treatment
...symptoms are refractory to simple l...
Anorectal tests and colonic transit should be...
...ubtotal colectomy rather than continuin...
...intraluminal testing (manometry, barostat) should...
...r enemas rather than oral laxatives alon...
...3. Treatment Algorithm for Chronic Constipati...
.... Treatment Algorithm for NTC an...
...ment Algorithm for Defecating Disorders...
...eutic Options for IBS-CHaving trouble...
...peutic Options for Functional Constipa...
Table 4. Common Drugs Causing Consti...
...ble 5. Summary of Dietary Supplements and...