Constipation

Diagnosis Table 2. Diagnostic Criteria for Functional Constipation and Dyssynergic Defecation Criteriaa for functional constipation (Rome III) 1- Must include two or more of the following: • straining during at least 25% of defecations • lumpy or hard stools in at least 25% of defecations • sensation of incomplete evacuation in at least 25% of defecations • sensation of anorectal obstruction/blockage in at least 25% of defecations • manual maneuvers to facilitate at least 25% of defecations (eg, digital evacuation, support of the pelvic floor) • fewer than three defecations per week Criteria for defecatory disorders Patients must fulfill all three criteria: 1- The diagnostic criteria for functional chronic constipation (Rome III) 2- Demonstrate dyssynergia during repeated attempts to defecate and a dyssynergic or obstructive pattern of defecation (Types 1-4), which is defined as a paradoxical increase in anal sphincter pressure (anal contraction) or less than 20% relaxation of the resting anal sphincter pressure or inadequate propulsive forces based on manometry, imaging or electromyography (EMG) 3- One or more of the following criteria during repeated attempts to defecate: • Inability to expel an artificial stool (50-mL water-filled balloon) within 1 min • Inability to evacuate or ≥ 50% retention of barium during defecography • Delayed colonic transit, especially when balloon expulsion test or defecography is normal, is recommended by some experts. Delayed colonic transit is defined by: ▶ more than five markers (≥ 20% marker retention) on a plain abdominal radiograph taken 120 h after ingestion of one Sitzmarks capsule containing 24 radiopaque markers OR ▶ a lower geometric center when colonic transit is measured by scintigraphy a Criteria fulfilled for the last 3 months with symptom onset at least 6 months before diagnosis. ) OR ▶ ≥ 59 hours of colonic transit time as measured by a wireless motility capsule (SmartPill® 2

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