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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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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). https://doi.org/10.1007/s11938-014-0025-8

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Keywords

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