Constipation Questions & Answers

Updated: Mar 28, 2017
  • Author: Marc D Basson, MD, PhD, MBA, FACS; Chief Editor: BS Anand, MD  more...
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Questions & Answers

Overview

How common is constipation?

What are the criteria for constipation and which complaints are related to constipation?

Which complaints suggest difficulty with rectal evacuation associated with constipation?

Which signs and symptoms associated with constipation are grounds for particular concern?

Which exams and studies are included in the workup of constipation?

What is the initial treatment of constipation?

What is the focus of medical care in constipation?

Which dietary measures are key to treating constipation?

Which medications and newer therapies are used in the treatment of constipation?

How common is constipation in the US?

What is the clinical definition of constipation?

What are the Rome III criteria for constipation?

What is the definition of constipation for surgical purposes?

What approach is indicated in acute or subacute constipation in middle-aged or elderly patients which condition must be excluded?

When is constipation defined as chronic?

Which lab studies, imaging studies, and procedures are used in the workup of constipation?

What is the focus of medical management of constipation and when is surgical care indicated?

How are the features of constipation characterized?

Which processes are involved in constipation originating from the colon or rectum?

What are the factors involved in constipation originating outside the colon?

Which symptoms and abnormalities are associated with constipation?

How common is constipation in patients with diverticular or anorectal disease?

How is the etiology of constipation categorized?

What are the subtypes of primary constipation?

What is normal-transit constipation (NTC) and what is the difference between chronic constipation and irritable bowel syndrome with constipation (IBS-C)?

How is slow-transit constipation (STC) characterized?

How is pelvic floor dysfunction/pelvic floor dyssynergia characterized in primary constipation?

Which dietary habits are associated with constipation?

What are structural causes of secondary constipation?

Which systemic diseases may cause constipation and which emergent conditions must be recognized and addressed?

Which medications can cause constipation?

What is the role of toxicologic causes or psychological issues in the development of constipation?

How prevalent is chronic constipation in the US?

What is the worldwide prevalence of constipation?

What are the age-related demographics of constipation and which conditions may lead to functional outlet obstruction?

Is constipation more common in men or women?

What are the race-related demographics of constipation?

What is the prognosis of constipation?

How are dyskinesias of the pelvic floor and sphincter mechanism managed in constipation?

What is the treatment of constipation associated with chronic use of laxatives?

When is a total abdominal colectomy indicated in the treatment of constipation?

Which symptoms may be caused by difficulties in defecation associated with constipation?

What are the potential adverse effects of self-medicating with laxatives in the treatment of constipation?

When is surgical intervention indicated in the treatment of hemorrhoidal disease due to straining associated with constipation?

Does constipation cause hemorrhoidal disease?

What is the role of constipation in anal fissures and how are they managed?

What is the role of constipation in pelvic floor damage?

What causes solitary rectal ulcers associated with constipation?

What are some of the complications of constipation?

What is the role of patient education in the management of constipation?

Presentation

What history is relevant in the workup of constipation?

Which patient complaints suggest constipation or difficult rectal evacuation?

Which signs and symptoms of constipation may indicate a more serious condition?

How is a health history interview conducted in the diagnosis of constipation?

What is the role of onset of symptoms and duration of the problem in the diagnosis of constipation?

What is the role of dietary practices in abnormal bowel habit associated with constipation?

How does fluid intake affect constipation?

Which factors influence bowel motility in constipation?

Which digestive conditions should be assessed in the setting of constipation?

Which patients with constipation should be screened for colorectal cancer?

What should the patient be asked to describe in the evaluation of constipation?

Which disorders and diseases are associated with constipation?

What is the role of psychogenic factors in constipation and how are they approached?

What is included in the physical exam in constipation?

What does abdominal distention, masses, or hernia indicate in the physical exam for constipation?

Should elderly patients with new inguinal hernias have colorectal screening for suspected occult constipation?

What should a pelvic exam in women with constipation address?

Which features of constipation are assessed in an anorectal exam?

What information is provided in a digital rectal exam?

Which causes of constipation can be identified in an anorectal exam?

How is rectal prolapse identified in patients with constipation and when is a sigmoidoscopy indicated?

How are the effects of constipation determined in a physical exam?

When is fecal occult blood testing indicated in the workup of constipation?

Which systems other than the digestive system should be evaluated in the physical evaluation for constipation and what are some systemic diseases associated with constipation?

DDX

What are diagnostic considerations in the differential diagnosis of constipation and which conditions other than gastroenterological should be considered?

What are the differential diagnoses for Constipation?

Workup

When is an extensive workup of constipation indicated and in which setting?

What is the role of lab studies in the initial assessment of constipation?

What is the role of imaging studies in the workup of constipation?

Which procedures are used in the evaluation of constipation?

Which procedures are indicated in the workup of acute constipation?

Which condition may be identified in a CBC and when is fecal occult blood testing indicated in the workup of constipation?

What is the role of a leukocyte count in the workup of constipation?

What is the role of thyroid function testing in the workup of constipation?

What is the role of serum chemistry in the workup of constipation?

When are imaging studies indicated in the workup of constipation?

Which signs of constipation can be distinguished in a radiograph?

Which conditions associated with diabetes may be seen in radiography studies for constipation?

When is abdominal CT scanning or lower GI endoscopy indicated in the workup of constipation?

When is air-contrast barium enema or Gastrografin study indicated in the workup of constipation?

When is defecography indicated in the workup of constipation?

When is an evaluation of colonic transit time indicated in the workup of constipation and how is the study performed?

When is urgent lower GI endoscopy indicated in the workup of constipation and when is colonoscopy contraindicated?

What are the advantages of flexible endoscopy over rigid endoscopy in the workup of constipation?

How is flexible endoscopy performed in the workup of constipation?

Which parameters are assessed in anorectal manometry in the workup of constipation?

How is idiopathic megabowel identified in the workup of constipation?

What is the role of electromyography (EMG) in the workup of constipation?

How is a balloon expulsion performed in the workup of constipation?

When is anoscopy indicated in the workup of constipation?

How is Hirschsprung disease diagnosed in the setting of constipation?

Which histology studies are indicated in the workup of constipation?

Treatment

What is the emergency department (ED) treatment of constipation after critical illness is excluded?

What is the focus of medical care in constipation and what is the FDA warning regarding OTC sodium phosphate products?

What is the best remedy in the treatment of constipation?

How should patients with constipation be counseled?

When is surgical intervention indicated in constipation?

When is inpatient care indicated in constipation?

Which factors may warrant transfer to another facility in the treatment of constipation?

How is treatment failure to provide adequate relief defined in chronic constipation?

What is the role of dietary changes in the treatment of constipation?

Which sources of dietary fiber and fiber supplements are available in the treatment of constipation?

How is a fiber supplement selected in the treatment of constipation?

How is patient noncompliance with fiber supplement regimens addressed in the treatment of constipation?

What should patients be advised regarding the use of stool softeners in the treatment of constipation?

What is the role of fluid intake in the treatment of constipation and which fluid is recommended?

What action is recommended when a high-fiber, high-water regimen fails in the treatment of constipation?

When is a very-low-residue diet or liquid diet indicated in the treatment of constipation and how effective are they?

Which medications are used to treat constipation?

How are sodium phosphate products used in the treatment of constipation?

What is the most effective approach in the use of fiber or polyethylene glycol in the treatment of constipation?

When are emollient stool softeners indicated in the treatment of constipation?

What is the role of lubricants and laxatives in the treatment of acute or chronic constipation?

Why does chronic constipation respond poorly to laxatives?

What are the novel therapies in the treatment of constipation?

How effective is prucalopride in the treatment of constipation?

How effective is lubiprostone in the treatment of constipation?

How is linaclotide used in the treatment of constipation and what was the FDA approval based on?

How is plecanatide used in the treatment of constipation and what was the FDA approval based on?

When are newer therapeutic drugs indicated in the treatment of constipation?

Which drugs have been investigated in the treatment of constipation?

When is surgical intervention indicated in the evaluation of constipation?

When is surgical treatment indicated in constipation?

How is benign outlet obstruction due to prolapse associated with constipation managed?

What is the role of sacral nerve stimulation in the treatment of constipation and how effective is it?

What causes constipation in pregnancy?

What is the first-line treatment of constipation in pregnancy?

How are acute and subacute hemorrhoidal complications minimized in constipation in the setting of pregnancy?

How common is constipation in elderly patients and what is the treatment?

What causes constipation in children and what are potential complications?

What causes a vicious cycle of constipation in children and what is the treatment?

What is the first-line therapy for constipation in children?

What is the treatment for mentally incapacitated patients with a pattern of bowel retention relative to constipation?

What is opioid-induced constipation (OIC)?

Which medications have been FDA approved to treat opioid-induced constipation (OIC)?

Which medication is used in the treatment of opioid-induced constipation (OIC) in adults with chronic noncancer pain and how effective is it?

When is surgical consultation indicated in constipation?

What is the initial treatment for prolonged chronic hemorrhoids and acute anal fissures associated with constipation?

What is the treatment of chronic nonhealing fissures associated with constipation?

What is the treatment for perirectal abscess and fistula in ano associated with constipation?

When is consultation with a gastroenterologist indicated in constipation?

Who may be consulted for lower GI endoscopy for constipation?

When is a psychological consultation indicated in constipation?

What outpatient care is indicated for acute constipation?

What outpatient care is indicated for chronic constipation?

Medications

Which medications are used in the treatment of constipation?

What is the FDA warning regarding OTC sodium phosphate products for constipation?

What is the role of emollient stool softeners in the treatment of constipation?

What is the role of lubricants and laxatives in the treatment of acute and chronic constipation?

How effective is polyethylene glycol in the management of chronic constipation?

What are the novel therapies for constipation?

Which medications in the drug class Laxatives, Bulk-Producing are used in the treatment of Constipation?

Which medications in the drug class Laxatives, Stool Softener are used in the treatment of Constipation?

Which medications in the drug class Laxative, Stimulant; Laxative, Stool Softener are used in the treatment of Constipation?

Which medications in the drug class Laxatives, Saline are used in the treatment of Constipation?

Which medications in the drug class Laxatives, Lubricant are used in the treatment of Constipation?

Which medications in the drug class Laxatives, Other are used in the treatment of Constipation?

Which medications in the drug class Laxatives, Osmotic are used in the treatment of Constipation?

Which medications in the drug class Stimulant Laxatives are used in the treatment of Constipation?

Which medications in the drug class Prokinetic Agents are used in the treatment of Constipation?

Which medications in the drug class Peripherally-Acting Mu-Opioid Receptor Antagonists (PAMORA) are used in the treatment of Constipation?