Constipation in adults - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

Constipation is initially evaluated with a detailed history and physical exam, including a digital rectal exam.
Diagnostic evaluation may include a colonoscopy if indicated, colonic transit study, anorectal manometry, and a balloon expulsion study.
Initial treatment consists of lifestyle modification and laxatives.
Medical treatment should be tailored to the underlying etiology. If the constipation does not respond to medical treatment, patients may need specialized evaluation for pelvic floor dysfunction and biofeedback therapy. Surgery is only rarely indicated.

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History & Exam
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Definition

Epidemiology

Etiology

Pathophysiology

Images

Diagnostic algorithm for constipation. Traditional laxatives include bulk laxatives, osmotic laxatives, stimulant laxatives, and stool softeners. See Management approach section for further details. AXR: abdominal x-ray
Treatment algorithm for constipation (non-opioid induced). PEG: polyethylene glycol (macrogols)
Summary of laxatives for chronic constipation

Citations

Key Articles

Bharucha AE, Dorn SD, Lembo A, et al. American Gastroenterological Association medical position statement on constipation. Gastroenterology. 2013 Jan;144(1):211-7.[Abstract][Full Text]
Serra J, Pohl D, Azpiroz F, et al. European society of neurogastroenterology and motility guidelines on functional constipation in adults. Neurogastroenterol Motil. 2020 Feb;32(2):e13762.[Abstract][Full Text]
Paquette IM, Varma M, Ternent C, et al. The American Society of Colon and Rectal Surgeons' clinical practice guideline for the evaluation and management of constipation. Dis Colon Rectum. 2016 Jun;59(6):479-92.[Abstract]
Crockett SD, Greer KB, Heidelbaugh JJ, et al. American Gastroenterological Association Institute guideline on the medical management of opioid-induced constipation. Gastroenterology. 2019 Jan;156(1):218-26.[Abstract][Full Text]
Chang L, Chey WD, Imdad A, et al. American Gastroenterological Association-American College of Gastroenterology clinical practice guideline: pharmacological management of chronic idiopathic constipation. Am J Gastroenterol. 2023 Jun 1;118(6):936-54.[Abstract][Full Text]

Referenced Articles

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