Constipation%20in%20adults%20-%20chronic%20functional Signs and Symptoms

Symptom-based Definition of Constipation

• Unsatisfactory defecation distinguished by difficult stool passage, infrequent stools (<3 bowel movements/week) or both
• Difficult stool passage may include:
  • Lumpy/hard stools 
  • Straining
  • Feeling of difficulty in passing stool
  • Feeling of anorectal blockade
  • Incomplete evacuation
  • Prolonged time to defecate
  • Need for manual maneuver to pass stool
  • Abdominal discomfort
• Other symptoms that may alert physician of an underlying constipation include bloating, fullness, and need for laxatives
• Chronic constipation is considered when the above symptoms have existed for ≥3 months

• Most recognized causes of constipation include sensorimotor disturbances in the colon and pelvic floor dysfunction 
• Symptoms of chronic constipation may be due to dysfunction of intestinal motility, visceral sensitivity, anorectal musculature or the enteric nervous system
• Functional constipation has no evidence of structural or metabolic disease to account for the symptoms  
  • Also known as chronic idiopathic constipation 
  • Risk factors for functional constipation include increasing age, female sex, and decreased caloric intake
  • Rome IV diagnostic criteria for functional constipation include:  
    • >2 of the following: Hard or lumpy stools >25% of bowel movements, manual maneuvers to facilitate >25% of bowel movements, sensation of incomplete evacuation >25% of bowel movements, sensation of anorectal blockage or obstruction >25% of bowel movements, straining during >25% of bowel movements, <3 spontaneous bowel movements/week
    • Loose stools are rarely seen with no laxative use
    • Insufficient criteria for irritable bowel syndrome (IBS)
    • Above criteria fulfilled for the last 3 months with symptoms starting at least 6 months before diagnosis
• Functional or primary constipation categories include normal or slow transit constipation, colonic inertia, pelvic floor dysfunction or outlet obstruction, and combination of causes, eg pelvic floor dysfunction and slow transit constipation

Alarm Signs and Symptoms

• If any of the following symptoms are present, a patient should undergo further diagnostic testing:
  • Weight loss >4.5 kg or ≥10% in 3 months
  • Loss of appetite
  • Vomiting
  • Acute onset of constipation in the elderly
  • Change in stool caliber
  • Family history of colon cancer or inflammatory bowel disease (IBD)
  • Fever
  • Abnormal physical signs (eg abdominal mass)
  • Rectal bleeding and/or prolapse
  • Hematochezia
  • Iron-deficiency anemia 
  • Positive fecal occult blood test
  • Polyposis syndromes