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Constipation in Adults: Diagnosis and Management

Opinion statement

Symptoms of constipation occur at all ages, with the greatest prevalence in individuals older than 60 years of age. It is estimated that 35 million individuals suffer from constipation in the USA, but only a small number will ever be diagnosed. Patients identify constipation symptoms differently than physicians. Whereas a patient may define their constipation by symptoms of bloating, distension, feeling of incomplete evacuation, abdominal discomfort, hard stools, and excessive straining, physicians often interpret prolonged timing between movements as the most essential criteria. An evaluation of constipation begins with a focused history of a person’s bowel habit, medications, diet, physical activity, and an anorectal examination. In the absence of alarm signs, diagnostic testing for constipation is not routinely recommended in the initial evaluation. First-line management includes lifestyle changes of increased physical activity, high-fiber diets, adequate fluid intake, and bowel management techniques such as a straight back sitting position, using known triggers to stimulate bowel contractions, and a foot stool to elevate knees above bottom during toileting. When refractory to initial management, patients should have anorectal manometry to assess outlet function; additional testing may be required. Biofeedback is an effective treatment option for dyssynergic defecation. A range of traditional and new pharmacologic therapies are available to remedy constipation, from stool softeners to agents that increase intestinal transit. Managing the primary and secondary causes of constipation, incorporating effective bowel management techniques, along with the judicious use of laxatives can reduce constipation symptoms and improve quality of life.

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References and Recommended Reading

  1. 1.

    Brandt LJ et al. Systematic review on the management of chronic constipation in North America. Am J Gastroenterol. 2005;100 Suppl 1:S5–21.

    PubMed  Article  Google Scholar 

  2. 2.

    Bharucha AE, Pemberton JH, Locke 3rd GR. American Gastroenterological Association technical review on constipation. Gastroenterology. 2013;144(1):218–38.

    PubMed Central  PubMed  Article  Google Scholar 

  3. 3.••

    Bharucha AE et al. American Gastroenterological Association medical position statement on constipation. Gastroenterology. 2013;144(1):211–7. This is the latest guideline published by the American Gastroenterological Association for the management of constipation. It clearly defines chronic constipation and directs physicians on diagnostic work-up and treatment plans. Given its recent publication it includes the latest drugs approved by the FDA for chronic constipation.

    PubMed  Article  Google Scholar 

  4. 4.

    Choung RS et al. Cumulative incidence of chronic constipation: a population-based study 1988-2003. Aliment Pharmacol Ther. 2007;26(11–12):1521–8.

    CAS  PubMed  Article  Google Scholar 

  5. 5.

    Higgins PD, Johanson JF. Epidemiology of constipation in North America: a systematic review. Am J Gastroenterol. 2004;99(4):750–9.

    PubMed  Article  Google Scholar 

  6. 6.

    Bosshard W et al. The treatment of chronic constipation in elderly people: an update. Drugs Aging. 2004;21(14):911–30.

    PubMed  Article  Google Scholar 

  7. 7.

    Talley NJ et al. Constipation in an elderly community: a study of prevalence and potential risk factors. Am J Gastroenterol. 1996;91(1):19–25.

    CAS  PubMed  Google Scholar 

  8. 8.

    Dennison C et al. The health-related quality of life and economic burden of constipation. Pharmacoeconomics. 2005;23(5):461–76.

    PubMed  Article  Google Scholar 

  9. 9.

    Nellesen D et al. A systematic review of the economic and humanistic burden of illness in irritable bowel syndrome and chronic constipation. J Manag Care Pharm. 2013;19(9):755–64.

    PubMed  Google Scholar 

  10. 10.

    Nellesen D et al. Comorbidities in patients with irritable bowel syndrome with constipation or chronic idiopathic constipation: a review of the literature from the past decade. Postgrad Med. 2013;125(2):40–50.

    PubMed  Article  Google Scholar 

  11. 11.

    Longstreth GF et al. Functional bowel disorders. Gastroenterology. 2006;130(5):1480–91.

    PubMed  Article  Google Scholar 

  12. 12.•

    Gallegos-Orozco JF et al. Chronic constipation in the elderly. Am J Gastroenterol. 2012;107(1):18–25. quiz 26.This article is a very comprehensive review of constipation with a primary focus on the elderly. It provides a thorough review of the pathophysiology of constipation.

    PubMed  Article  Google Scholar 

  13. 13.

    Ness J et al. Anticholinergic medications in community-dwelling older veterans: prevalence of anticholinergic symptoms, symptom burden, and adverse drug events. Am J Geriatr Pharmacother. 2006;4(1):42–51.

    CAS  PubMed  Article  Google Scholar 

  14. 14.

    Traube M, McCallum RW. Calcium-channel blockers and the gastrointestinal tract. American College of Gastroenterology's Committee on FDA related matters. Am J Gastroenterol. 1984;79(11):892–6.

    CAS  PubMed  Google Scholar 

  15. 15.

    Rao SS, Singh S. Clinical utility of colonic and anorectal manometry in chronic constipation. J Clin Gastroenterol. 2010;44(9):597–609.

    PubMed  Article  Google Scholar 

  16. 16.

    Fletcher JG et al. Magnetic resonance imaging of anatomic and dynamic defects of the pelvic floor in defecatory disorders. Am J Gastroenterol. 2003;98(2):399–411.

    CAS  PubMed  Article  Google Scholar 

  17. 17.

    Diamant NE et al. AGA technical review on anorectal testing techniques. Gastroenterology. 1999;116(3):735–60.

    CAS  PubMed  Article  Google Scholar 

  18. 18.

    Saad RJ, Hasler WL. A technical review and clinical assessment of the wireless motility capsule. Gastroenterol Hepatol (N Y). 2011;7(12):795–804.

    Google Scholar 

  19. 19.

    Chiarioni G, Salandini L, Whitehead WE. Biofeedback benefits only patients with outlet dysfunction, not patients with isolated slow transit constipation. Gastroenterology. 2005;129(1):86–97.

    PubMed  Article  Google Scholar 

  20. 20.

    Gudsoorkar VS, Quigley EM. Emerging treatments for chronic constipation. Expert Opin Emerg Drugs. 2013;18(3):365–73.

    CAS  PubMed  Article  Google Scholar 

  21. 21.

    Bijkerk CJ et al. Soluble or insoluble fibre in irritable bowel syndrome in primary care? Randomised placebo controlled trial. BMJ. 2009;339:b3154.

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  22. 22.

    Bijkerk CJ et al. Systematic review: the role of different types of fibre in the treatment of irritable bowel syndrome. Aliment Pharmacol Ther. 2004;19(3):245–51.

    CAS  PubMed  Article  Google Scholar 

  23. 23.

    Voderholzer WA et al. Clinical response to dietary fiber treatment of chronic constipation. Am J Gastroenterol. 1997;92(1):95–8.

    CAS  PubMed  Google Scholar 

  24. 24.

    Xing JH, Soffer EE. Adverse effects of laxatives. Dis Colon Rectum. 2001;44(8):1201–9.

    CAS  PubMed  Article  Google Scholar 

  25. 25.

    Szojda MM, Mulder CJ, Felt-Bersma RJ. Differences in taste between two polyethylene glycol preparations. J Gastrointest Liver Dis. 2007;16(4):379–81.

    Google Scholar 

  26. 26.

    Nyberg C, Hendel J, Nielsen OH. The safety of osmotically acting cathartics in colonic cleansing. Nat Rev Gastroenterol Hepatol. 2010;7(10):557–64.

    PubMed  Article  Google Scholar 

  27. 27.

    Ainley EJ, Winwood PJ, Begley JP. Measurement of serum electrolytes and phosphate after sodium phosphate colonoscopy bowel preparation: an evaluation. Dig Dis Sci. 2005;50(7):1319–23.

    CAS  PubMed  Article  Google Scholar 

  28. 28.

    Ford AC, Suares NC. Effect of laxatives and pharmacological therapies in chronic idiopathic constipation: systematic review and meta-analysis. Gut. 2011;60(2):209–18.

    PubMed  Article  Google Scholar 

  29. 29.

    Lacy BE, Levy LC. Lubiprostone: a novel treatment for chronic constipation. Clin Interv Aging. 2008;3(2):357–64.

    CAS  PubMed Central  PubMed  Google Scholar 

  30. 30.

    Gras-Miralles B, Cremonini F. A critical appraisal of lubiprostone in the treatment of chronic constipation in the elderly. Clin Interv Aging. 2013;8:191–200.

    CAS  PubMed Central  PubMed  Google Scholar 

  31. 31.

    Camilleri M et al. Effect of a selective chloride channel activator, lubiprostone, on gastrointestinal transit, gastric sensory, and motor functions in healthy volunteers. Am J Physiol Gastrointest Liver Physiol. 2006;290(5):G942–7.

    CAS  PubMed  Article  Google Scholar 

  32. 32.

    Lacy BE, Chey WD. Lubiprostone: chronic constipation and irritable bowel syndrome with constipation. Expert Opin Pharmacother. 2009;10(1):143–52.

    CAS  PubMed  Article  Google Scholar 

  33. 33.

    Barish CF et al. Efficacy and safety of lubiprostone in patients with chronic constipation. Dig Dis Sci. 2010;55(4):1090–7.

    CAS  PubMed  Article  Google Scholar 

  34. 34.

    Harris LA, Crowell MD. Linaclotide, a new direction in the treatment of irritable bowel syndrome and chronic constipation. Curr Opin Mol Ther. 2007;9(4):403–10.

    CAS  PubMed  Google Scholar 

  35. 35.

    Johnston JM et al. Linaclotide improves abdominal pain and bowel habits in a phase IIb study of patients with irritable bowel syndrome with constipation. Gastroenterology. 2010;139(6):1877–1886 e2.

    CAS  PubMed  Article  Google Scholar 

  36. 36.

    Silos-Santiago I et al. Gastrointestinal pain: Unraveling a novel endogenous pathway through uroguanylin/guanylate cyclase-C/cGMP activation. Pain. 2013;154(9):1820–30.

    CAS  PubMed  Article  Google Scholar 

  37. 37.

    Lacy BE, Levenick JM, Crowell MD. Linaclotide: a novel therapy for chronic constipation and constipation-predominant irritable bowel syndrome. Gastroenterol Hepatol (N Y). 2012;8(10):653–60.

    Google Scholar 

  38. 38.

    Lembo AJ et al. Efficacy of linaclotide for patients with chronic constipation. Gastroenterology. 2010;138(3):886–95 e1.

    CAS  PubMed  Article  Google Scholar 

  39. 39.••

    Rothstein RD, Friedenberg FK. Linaclotide: a novel compound for the treatment of irritable bowel syndrome with constipation. Expert Opin Pharmacother. 2013;14(15):2125–32. This study demonstrated the efficacy of linaclotide and helped it gain FDA approval. Linaclotide is the latest agent approved by the FDA for chronic constipation.

    CAS  PubMed  Article  Google Scholar 

  40. 40.

    Thayalasekeran S, Ali H, Tsai HH. Novel therapies for constipation. World J Gastroenterol. 2013;19(45):8247–51.

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  41. 41.

    Camilleri M et al. A placebo-controlled trial of prucalopride for severe chronic constipation. N Engl J Med. 2008;358(22):2344–54.

    CAS  PubMed  Article  Google Scholar 

  42. 42.

    Costilla VC, Foxx-Orenstein AE. Constipation: understanding mechanisms and management. Clin Geriatr Med. 2014;30(1):107–15.

    PubMed  Article  Google Scholar 

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Compliance with Ethics Guidelines

Conflict of Interest

Vanessa C. Costilla declares that she has no conflict of interest.

Amy E. Foxx-Orenstein has received consultancy fees, speaker honorarium, and travel accommodation from Ironwood and Forest.

No funding was received for this paper.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Correspondence to Amy E. Foxx-Orenstein DO.

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Costilla, V.C., Foxx-Orenstein, A.E. Constipation in Adults: Diagnosis and Management. Curr Treat Options Gastro 12, 310–321 (2014).

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  • Chronic constipation
  • Anorectal manometry
  • Pelvic floor dysfunction
  • Outlet dysfunction
  • Delayed transit constipation
  • Constipation management