Issue link: https://eguideline.guidelinecentral.com/i/84987
Key Points ÎConstipation is a symptom-based disorder characterized by one or more bowel symptoms (ie, infrequent stools, hard stools, difficult stool passage), which may be associated with decreased quality of life. (C) ÎChronic constipation (CC) is defined as the presence of the following symptoms for at least 3 months: • Difficult stool passage that includes straining, a sense of incomplete evacuation, hard/lumpy stools • Prolonged time to pass stool • Need for manual maneuvers to pass stool. (C) ÎMost studies estimate that the prevalence of CC is approximately 15%. Constipation is reported more commonly in women (2-3:1 predominance), the elderly, non-whites, and individuals from lower socioeconomic groups. (C) ÎTreatment of patients with CC is indicated when the symptoms are persistent, bothersome or diminish quality of life. (C) ÎToday, diagnostic tests are available that should identify a pathophysiological mechanism or cause for constipation in most patients. ÎColon-specific drugs, laxatives and biofeedback therapy should alleviate constipation in a majority of patients. Diagnosis ÎA careful history and physical examination should be performed in order to identify symptoms or signs of organic disorders (eg, hypothyroidism) that may be associated with CC symptoms. ÎBased upon expert opinion, the routine approach to a patient with symptoms of CC without alarm signs or symptoms should be empiric treatment without performance of diagnostic testing. (C) • Specific diagnostic testing (eg, thyroid function tests or colonoscopy) may be performed in individual patients with additional signs or symptoms of an organic disorder. (C) • Patients with alarm symptoms (Table 1) should undergo further diagnostic studies. (C) ÎAmong CC patients < 45 years without alarm symptoms or signs, there are inadequate data to make a recommendation about the routine use of flexible sigmoidoscopy, colonoscopy, barium enema, thyroid function tests, serum calcium, and other diagnostic tests. (C) • Routine use of colon cancer screening tools is recommended for all patients ≥ 50 years old. (C)