Constipation in Emergency Medicine
- Author: Dave A Holson, MD, MBBS, MPH; Chief Editor: Barry E Brenner, MD, PhD, FACEP more...
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.
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.
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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