Constipation in Emergency Medicine 

  • Author: Dave A Holson, MD, MBBS, MPH; Chief Editor: Barry E Brenner, MD, PhD, FACEP   more...
 
Updated: Jun 14, 2010
 

Background

Constipation is a symptom rather than a disease and is the most common digestive complaint in the United States. It is a common gastrointestinal motility disorder that is often chronic and significantly impacts the patient's quality of life and is associated with significant health care costs. Constipation is classified as chronic if it occurred for 12 weeks during the previous year, although these weeks need not be consecutive. No widely accepted clinically useful definition of constipation exists. Health care providers usually use the frequency of bowel movements (ie, less than 3 bowel movements per week) to define constipation. However, the Rome criteria, initially introduced in 1988 and subsequently modified twice (Rome III), has become the research standard definition of constipation.[1]

Rome III criteria requires a patient to have experienced at least 2 of the following symptoms of constipation over the past 3 months:

  • Less than 3 bowel movements per week
  • Straining
  • Lumpy/hard stools
  • Sensation of anorectal obstruction
  • Sensation of incomplete defecation
  • Manual maneuvering required to defecate

The Rome III criteria also stipulate that a patient should not meet the suggested criteria for irritable bowel syndrome (IBS) and that loose stools are rarely present without the use of laxatives.

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Pathophysiology

Constipation results from a colonic or anorectal functional disorder. The first step in managing constipation is to determine whether the patient's symptoms are due to a primary versus a secondary cause.

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Epidemiology

Frequency

United States

Chronic constipation is highly prevalent and affects approximately 15% in the United States.[2] In 2006, the number of constipation-related physician visits reached 5.7 million, and, of these, 2.7 million visits had constipation as the primary diagnosis.[3]

International

Chronic constipation affects approximately 63 million people in North America alone. Approximately 12% of people worldwide suffer from self-defined constipation; people in the Americas and Asian Pacific suffer twice as much as their European counterparts.

Mortality/Morbidity

Most patients with constipation can be treated medically, resulting in complete success or improvement. However, a small percentage of patients are quite debilitated as a result of constipation. Some patients with functional (primary or idiopathic) constipation (ie, colonic inertia) require total abdominal colectomy with ileorectal anastomosis.

Race

Compared with whites, the prevalence of constipation is 30% higher among nonwhite populations.[2]

Sex

The male-to-female ratio is approximately 1:3. Women are also more likely to receive care for constipation. The condition is seen fairly frequently during pregnancy and is a common problem after childbirth.

Age

Constipation can occur in all ages, from newborns to elderly persons. An age-related increase in the incidence of constipation exists, with 30-40% of adults older than 65 years citing constipation as a problem.[4]

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Contributor Information and Disclosures
Author

Dave A Holson, MD, MBBS, MPH  Assistant Professor of Emergency Medicine, Mount Sinai School of Medicine; Director, Department of Emergency Medicine, Queens Hospital Center

Dave A Holson, MD, MBBS, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, National Medical Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

William K Chiang, MD  Associate Professor, Department of Emergency Medicine, New York University School of Medicine; Chief of Service, Department of Emergency Medicine, Bellevue Hospital Center

William K Chiang, MD is a member of the following medical societies: American Academy of Clinical Toxicology, American College of Medical Toxicology, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Eugene Hardin, MD, FAAEM, FACEP  Former Chair and Associate Professor, Department of Emergency Medicine, Charles Drew University of Medicine and Science; Former Chair, Department of Emergency Medicine, Martin Luther King Jr/Drew Medical Center

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Barry E Brenner, MD, PhD, FACEP  Professor of Emergency Medicine, Professor of Internal Medicine, Program Director, Emergency Medicine, University Hospitals, Case Medical Center

Barry E Brenner, MD, PhD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Chest Physicians, American College of Emergency Physicians, American College of Physicians, American Heart Association, American Thoracic Society, Arkansas Medical Society, New York Academy of Medicine, New York Academy of Sciences, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

References

  1. Longstreth GF, Thompson WG, Chey WD, Houghton LA, Mearin F, Spiller RC. Functional bowel disorders. Gastroenterology. Apr 2006;130(5):1480-91. [Medline].

  2. Staats PS, Markowitz J, Schein J. Incidence of constipation associated with long-acting opioid therapy: a comparative study. South Med J. Feb 2004;97(2):129-34. [Medline].

  3. Martin BC, Barghout V, Cerulli A. Direct medical costs of constipation in the United States. Manag Care Interface. Dec 2006;19(12):43-9. [Medline].

  4. Sonnenberg A, Koch TR. Epidemiology of constipation in the United States. Dis Colon Rectum. Jan 1989;32(1):1-8. [Medline].

  5. [Guideline] Ternent CA, Bastawrous AL, Morin NA, Ellis CN, Hyman NH, Buie WD. Practice parameters for the evaluation and management of constipation. Dis Colon Rectum. Dec 2007;50(12):2013-22. [Medline]. [Full Text].

  6. Kapoor S. Management of constipation in the elderly: emerging therapeutic strategies. World J Gastroenterol. Sep 7 2008;14(33):5226-7. [Medline]. [Full Text].

  7. Camilleri M, Kerstens R, Rykx A, Vandeplassche L. A placebo-controlled trial of prucalopride for severe chronic constipation. N Engl J Med. May 29 2008;358(22):2344-54. [Medline]. [Full Text].

  8. Camilleri M. Alvimopan, a selective peripherally acting mu-opioid antagonist. Neurogastroenterol Motil. Apr 2005;17(2):157-65. [Medline].

  9. Kraft MD. Emerging pharmacologic options for treating postoperative ileus. Am J Health Syst Pharm. Oct 15 2007;64(20 Suppl 13):S13-20. [Medline].

  10. Sweetser S, Busciglio IA, Camilleri M, et al. Effect of a chloride channel activator, lubiprostone, on colonic sensory and motor functions in healthy subjects. Am J Physiol Gastrointest Liver Physiol. Feb 2009;296(2):G295-301. [Medline]. [Full Text].

  11. Johanson JF, Morton D, Geenen J, Ueno R. Multicenter, 4-week, double-blind, randomized, placebo-controlled trial of lubiprostone, a locally-acting type-2 chloride channel activator, in patients with chronic constipation. Am J Gastroenterol. Jan 2008;103(1):170-7. [Medline].

  12. Barish CF, Drossman D, Johanson JF, Ueno R. Efficacy and safety of lubiprostone in patients with chronic constipation. Dig Dis Sci. Apr 2010;55(4):1090-7. [Medline].

  13. Pharmaceutical Business Review. Ironwood Pharma, Forest Labs Present Linaclotide Phase 3 Trial Results. pharmaceutical-business-review.com. Available at http://clinicaltrials.pharmaceutical-business-review.com/news/ironwood_pharma_forest_labs_present_linaclotide_phase_3_trial_results_100504/. Accessed May 4, 2010.

  14. Lembo AJ, Kurtz CB, Macdougall JE, Lavins BJ, Currie MG, Fitch DA. Efficacy of linaclotide for patients with chronic constipation. Gastroenterology. Mar 2010;138(3):886-95.e1. [Medline].

  15. Johanson JF. Review of the treatment options for chronic constipation. MedGenMed [serial online]. May 2, 2007;9 (2):25-40. Accessed April 26, 2010. Available at http://www.medscape.com/viewarticle/550956.

  16. [Best Evidence] [Guideline] Eoff JC. Optimal treatment of chronic constipation in managed care: review and roundtable discussion. J Manag Care Pharm. Nov 2008;14(9 Suppl A):1-15. [Medline]. [Full Text].

  17. Halligan S, Bartram CI. The radiological investigation of constipation. Clin Radiol. Jul 1995;50(7):429-35. [Medline].

  18. Harari D, Gurwitz JH, Avorn J, Bohn R, Minaker KL. How do older persons define constipation? Implications for therapeutic management. J Gen Intern Med. Jan 1997;12(1):63-6. [Medline]. [Full Text].

  19. Johanson JF, Sonnenberg A, Koch TR. Clinical epidemiology of chronic constipation. J Clin Gastroenterol. Oct 1989;11(5):525-36. [Medline].

  20. Lacy BE, Levy LC. Lubiprostone: a novel treatment for chronic constipation. Clin Interv Aging. 2008;3(2):357-64. [Medline]. [Full Text].

  21. Lacy BE, Levy LC. Lubiprostone: a novel treatment for chronic constipation. Clin Interv Aging. 2008;3(2):357-64. [Medline]. [Full Text].

  22. Lembo A, Camilleri M. Chronic constipation. N Engl J Med. Oct 2 2003;349(14):1360-8. [Medline].

  23. Martin H, Slyk MP, Deymann S, Cornacchione MJ. Safety profile assessment of risperidone and olanzapine in long-term care patients with dementia. J Am Med Dir Assoc. Jul-Aug 2003;4(4):183-8. [Medline].

  24. Mezwa DG, Feczko PJ, Bosanko C. Radiologic evaluation of constipation and anorectal disorders. Radiol Clin North Am. Nov 1993;31(6):1375-93. [Medline].

  25. Rantis PC Jr, Vernava AM 3rd, Daniel GL, Longo WE. Chronic constipation--is the work-up worth the cost?. Dis Colon Rectum. Mar 1997;40(3):280-6. [Medline].

  26. Schiller LR. New and emerging treatment options for chronic constipation. Rev Gastroenterol Disord. 2004;4 Suppl 2:S43-51. [Medline].

  27. Shafik A. Constipation. Pathogenesis and management. Drugs. Apr 1993;45(4):528-40. [Medline].

  28. Sonnenberg A, Koch TR. Epidemiology of constipation in the United States. Dis Colon Rectum. Jan 1989;32(1):1-8. [Medline].

  29. Velio P, Bassotti G. Chronic idiopathic constipation: pathophysiology and treatment. J Clin Gastroenterol. Apr 1996;22(3):190-6. [Medline].

 
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