What is constipation?

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Constipation is difficulty in passing stool. This causes bowel movements to be infrequent or require greater effort. Although it is usually a symptom that occurs for a limited time, it can become a chronic problem and seriously affect the quality of life of patients who suffer from it. 

Knowing the causes associated with its appearance, preventing them, carrying out a proper diagnosis and correctly using the different therapeutic tools available are essential measures in improving this symptom and the associated complications.

Non-pharmacological measures are always the first step in a therapeutic approach and include lifestyle changes.

Constipation | PortalCLÍNIC
Non-pharmacological measures are always the first step in treatment, and this means lifestyle changes.

Constipation is a subjective manifestation defined by a series of symptoms, including number of bowel movements, consistency and shape of the stool, and the effort and satisfaction obtained after the bowel movement.  

Types of Constipation

Primary chronic constipation 

This is the most common and is included within gut-brain axis disorders. Although the mechanisms are not fully understood, several factors are considered to be involved: Visceral hypersensitivity (increased internal organ pain sensitivity), functional sensory and motor disturbances, slow colonic transit, disturbances in central perception (distortions in the way sensory information is interpreted), and functional defecation disorders.

Based on the predominant symptoms, primary chronic constipation is divided into three subtypes: functional chronic constipation, irritable bowel syndrome with constipation and functional defecation disorders.

The definition of functional chronic constipation includes a chronic course of symptoms and is based on clinical criteria after excluding secondary causes. It is due to primary functional disturbances of the colon and anorectum and is defined by the Rome IV criteria (Table). It can be divided into three subgroups: 

  • Normal colonic transit constipation. This represents the most common group (60% of NTC cases). Stool transit time through the colon is normal and patients are thought to perceive bowel frequency badly.
  • Slow colonic transit constipation (STC, also called colonic inertia). 20% of patients have a lower frequency of high-amplitude colonic contractions; i.e., those that propel the colonic contents over long distances. Thus, it takes longer for intestinal material to travel through the colon compared to normal. As intestinal contents remain in the colon longer, water and electrolyte absorption increases, decreasing their volume and making them harder. This effect leads to difficulty evacuating and the formation of faecaliths (accumulation of hard stool in the rectum or colon) in some cases. 
  • Functional defecation disorders. Difficulty emptying the rectum is detected. Occasionally, this occurs in the context of neurological disorders, spinal cord injuries or anatomical abnormalities, such as rectocele (bulging of the rectum into the vaginal wall) or enterocele (descent of the small intestine into the pelvic cavity). However, in most cases, no structural or medical abnormality is found to justify it. 

Rome IV diagnostic criteria for Functional Chronic Constipation

  1. Al least two of the following criteria:
  • In more than 25% of cases:
    • Excessive straining.
    • Hard stools.
    • Feeling of incomplete evacuation.
    • Sensation of anorectal obstruction or blockage.
    • Manual aid to help with bowel movements.
  • Fewer than three complete spontaneous bowel movements per week.
  1. The presence of loose stools is rare without the use of laxatives.
  1. There should be insufficient criteria for the diagnosis of irritable bowel syndrome.

*The criteria must have been met for at least the last 3 months, with symptoms beginning at least 6 months before diagnosis.

Secondary Chronic Constipation

This is less common overall and can result from an illness, using certain medications or experiencing structural changes.

How many people are affected?

Constipation is a common health problem around the world. The global prevalence is estimated at 15-20% of the general population, increasing to over 70% in institutionalised elderly patients. The frequency in women is double that of men.

Substantiated information by:

Faust Feu Caballé
Francesc Balaguer Prunes
Sabela Carballal Ramil

Published: 21 July 2020
Updated: 21 July 2020

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