Constipation Definition and Diagnosis

Clinical Definition and Symptoms

Constipation is diagnosed when a patient presents with at least two of the following symptoms for at least 12 weeks in the previous 12 months: straining during bowel movements, lumpy or hard stool, sensation of incomplete evacuation, sensation of anorectal blockage or obstruction, manual evacuation procedures to remove stool, or fewer than 3 bowel movements per week, according to the Rome III Criteria 1, 2, 3, 4, 5
The experience of constipation involves measurable objective symptoms, including stool characteristics and frequency of defecation, as well as patient perception, level of discomfort, and ease of defecation 1, 6

Normal bowel function involves colonic absorption of fluids and transport of waste through peristalsis, active reabsorption of sodium and water, rectal distension leading to the urge to defecate, and an average colonic transit time of 20-72 hours 2

Constipation is a symptom, not a disease, and is a significant source of morbidity and distress 1, 2, 3
Constipation can be associated with complications including hemorrhoids, anal fissures, bowel obstruction, and urinary retention if left untreated 3
Opioid-induced constipation is defined as constipation triggered or worsened by opioid analgesics, according to the Rome IV criteria 1, 7