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CONSTIPATION IN ADULTS - CHRONIC FUNCTIONAL
Constipation is an unsatisfactory defecation distinguished by difficult stool passage, infrequent stools or both.
Difficult stool passage may include straining, feeling of difficulty in passing stool, incomplete evacuation, lumpy/hard stools, prolonged time to defecate, need for manual maneuver to pass stool, abdominal discomfort and feeling of anorectal blockade.
Chronic constipation is considered when symptoms of constipation have existed ≥3 months.
Symptoms of chronic constipation may be due to dysfunction of intestinal motility, visceral sensitivity, anorectal musculature or the enteric nervous system.

Patient Education

  • Engage in regular exercise
  • Inform patient that therapy is comprehensive in order to restore the defecation physiology
  • Reassure and explain about normal bowel habits
    • Encourage patients to defecate when colonic activity is highest (eg upon waking, after meals)

Lifestyle Modification

Dietary Modification

  • Patients should be advised to gradually increase their soluble dietary fiber
    • If possible, dietary fiber via fruits, vegetables and whole grains should be increased to 20-30 g/day
    • If this is not effective, commercial fiber supplements (bulk-producing laxatives) may be added, avoid if bloating is present
  • Patients may be encouraged to maintain adequate hydration (2-2.5 L/day), though increased fluid intake does not appear to relieve chronic constipation except in those who are dehydrated
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