Chronic constipation in adults

• Published in: BMJ 2009-03, Vol.338 (7697), p.763-766
• Main Authors: McCallum, Iain J D, Ong, Sarah, Mercer-Jones, Mark
• Format: Article
• Language: English
• Subjects: Adult; Adults; Analgesics - therapeutic use; Biofeedback; Cathartics; Chronic constipation; Chronic Disease; Clinical Review; Constipation; Constipation - diagnosis; Constipation - etiology; Constipation - therapy; Defecation; Defecation - physiology; Diagnosis; Disease management; Excretory system; Gastroenterology; Gastrointestinal Transit; Humans; Hypothyroidism; Intervention; Intestinal Obstruction - complications; Intestinal Obstruction - therapy; Irritable bowel syndrome; Irritable Bowel Syndrome - complications; Laxatives; Medical referrals; Pain - etiology; Pelvic floor; Posture; Prevention; Primary care; Primary health care; Psychotherapy - methods; Rectal Diseases - complications; Rectal Diseases - therapy; Referral and Consultation; Surgery; Symptoms; Treatment Outcome
• ISSN: 0959-8138; 0959-535X; 1468-5833; 1756-1833
• DOI: 10.1136/bmj.b831

Presence of two or more of the following symptoms: -Straining during at least 25% of defecations -Lumpy or hard stools in at least 25% of defecations -Sensation of incomplete evacuations for at least 25% of defecations -Sensation of anorectal obstruction/blockage for at least 25% of defecations -Manual manoeuvres to facilitate at least 25% of defecations (such as digital evacuation, support of the pelvic floor) -Fewer than three bowel movements a week Loose stools are rarely present without the use of laxatives *Criteria have to have been met for the previous three months, with the onset of symptoms six months prior to diagnosis Who gets chronic constipation? Since the most recent Rome criteria were published, a well conducted Spanish epidemiological study found that the prevalence of self reported constipation was 29.5% yet only half of those met the Rome criteria. 2 This study found that females had a higher incidence of constipation than males and that physical exercise and a high fibre diet were protective. The cause of slow transit constipation (and whether this is the same in all patients with slow transit) remains to found; an answer might guide therapeutic options, although all options in slow transit constipation are supported only by low level evidence Sacral nerve stimulation may present a therapeutic breakthrough, although evidence on this is extremely limited Additional educational resources Rome Foundation ( www.romecriteria.org )-Publishes guidelines on the diagnosis and management of a range of functional gastrointestinal disorders British Society of Gastroenterology ( www.bsg.org.uk )-Publishes guidelines for the management of irritable bowel syndrome and other causes of chronic constipation Core ( www.corecharity.org.uk )-This charity for research and information on gut and liver disease provides a useful information leaflet for patients on constipation