Clinical Review

Chronic constipation in adults

BMJ 2009; 338 doi: http://dx.doi.org/10.1136/bmj.b831 (Published 20 March 2009) Cite this as: BMJ 2009;338:b831
  1. Iain J D McCallum, specialty registrar,
  2. Sarah Ong, speciality registrar,
  3. Mark Mercer-Jones, consultant colorectal surgeon
  1. 1Colorectal Unit, Queen Elizabeth Hospital, Gateshead Health NHS Foundation Trust, Gateshead NE9 6SX
  1. Correspondence to: M Mercer-Jones mark.mercer-jones{at}ghnt.nhs.uk
  • Accepted 16 January 2009

Summary points

  • Chronic constipation is a common and debilitating condition

  • Many cases can be managed in primary care with simple measures

  • Investigations can often identify a cause for resistant constipation and thus guide treatment

  • Targeted surgery can be of great benefit to carefully selected patients

Chronic constipation in adults is a common and often debilitating problem that may present to almost any medical practitioner as it can have many causes. The most recent Rome criteria provide a useful research and clinical tool for defining chronic, functional constipation (box 1).1 For the problem to be described as chronic, the Rome criteria need to have been met for the previous three months, with the onset of symptoms six months prior to diagnosis. We prefer a more inclusive definition of chronic constipation: any patient experiencing consistent difficulty with defecation. This review examines the evidence for the modern approach to treating chronic constipation and is based largely on systematic reviews and randomised controlled trials where these are available.

Box 1 Rome criteria*

  • Presence of two or more of the following symptoms:

    • -Straining during at least 25% of defecations

    • -Lumpy or hard stools in at least 25% of defecations

    • -Sensation of incomplete evacuations for at least 25% of defecations

    • -Sensation of anorectal obstruction/blockage for at least 25% of defecations

    • -Manual manoeuvres to facilitate at least 25% of defecations (such as digital evacuation, support of the pelvic floor)

    • -Fewer than three bowel movements a week

  • Loose stools are rarely present without the use of laxatives

  • *Criteria have to have been met for the previous three months, with the onset of symptoms six months prior to diagnosis

Who gets chronic constipation?

Since the most recent Rome criteria were published, a well conducted Spanish epidemiological study found that the prevalence of self reported constipation was 29.5% yet only half of those met the Rome criteria.2 This …

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