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A systematic search of the medical literature was performed on September 1, 2005. The search, limited to human subjects and journals in English language, included the National Guidelines Clearinghouse, the Cochrane database, PubMed, and UpToDate®.

Constipation is a highly prevalent condition, especially in the older adult population. It is estimated that the prevalence of chronic constipation in North America varies between 2% and 27%.1 Constipation is generally more common in women, older adults, nonwhites, and patients of lower socioeconomic status.1


Constipation can be assessed by using several variables such as stool frequency, stool size or consistency, and other related symptoms. It is important to keep in mind that all patients have individual bowel habits. Therefore, the frequency of bowel movements may not be the most reliable method to assess constipation.1 The Rome II criteria is a standardized tool that diagnoses functional constipation as two or more of the criteria listed in Table 14-1 for at least 12 weeks during the preceding year with symptoms occurring at least 25% of the time.2

Table 14-1. Rome II Criteria for Functional Constipation

The knowledge of the criteria given in Table 14-1 can be used as a guide in the clinic setting. However, it is important to remember that symptoms can vary depending upon the individual bowel habits of the patients. Patients having daily bowel movements may complain of occasional constipation.3 Symptoms of constipation may arise secondary to other conditions such as primary diseases of the colon, metabolic disturbances, and neurologic disorders as listed in Table 14-2.3–5

Table 14-2. Organic Diseases Associated with Constipation3–5


Constipation arises from two disorders of colorectal motility. The first disorder, slow-transit constipation, or “colonic inertia,” refers to slower-than-normal movement of fecal contents from the proximal to the distal colon and rectum. There are two proposed mechanisms that lead to slow colonic transit: (1) decreased peristaltic contractions and (2) uncoordinated motor activity in the distal colon. Pelvic floor dysfunction is another major disorder of colorectal motility. This condition leads to an inability to evacuate contents ...

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