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Source: Fabel PH, Shealy KM. Diarrhea, constipation, and irritable bowel syndrome. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM, eds. Pharmacotherapy: A Pathophysiologic Approach. 10th ed. New York, NY: McGraw-Hill; 2017. http://accesspharmacy.mhmedical.com/content.aspx?bookid=1861§ionid=146059459. Accessed April 13, 2017.
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Constipation is not a disease but symptom of underlying disease or problem.
Drugs that inhibit neurologic or muscular function of gastrointestinal (GI) tract, particularly colon, may result in constipation (Table 1).
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Prevalence depends on the definition used and whether the condition is self-reported or provider-diagnosed.
Prevalence in North America ranges from 12% to 19%.
More common in women and the elderly.
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CLINICAL PRESENTATION
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Infrequent bowel movements.
Stools that are hard, small, or dry.
Difficulty or pain on defecation.
Feeling of abdominal discomfort or bloating.
Incomplete evacuation.
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MEANS OF CONFIRMATION AND DIAGNOSIS
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History and physical examination to clarify what patient means by constipation. Ask specifically about alarm signs and symptoms:
Hematochezia.
Melena.
Family history of colon cancer.
Family history of inflammatory bowel disease.
Anemia.
Weight loss.
Anorexia.
Nausea.
Vomiting.
Persistent constipation refractory to treatment.
New onset or worsening constipation in elderly patients without evidence of primary cause.
Rectal examination should be performed for presence of anatomical abnormalities, stricture, rectal mass, or fecal impaction.
Identify underlying secondary causes or conditions.