Comprehensive Assessment of Constipation

Medical History Components

The medical history should elicit key facts when constipation is suspected, including date of last defecation and frequency of bowel movements, consistency of the stool and recent changes in bowel patterns, presence or absence of urge to defecate, sensation of evacuation, presence or absence of faecal incontinence, evidence of blood or mucus on defecation, current and previous laxative use, and need for digital manipulation to assist or manage evacuation 2, 3, 4
A thorough medical history is essential to identify potential causes of constipation, such as medication use, level of physical activity, pre-existing irritable bowel syndrome or diverticular disease, and other comorbid diseases 1, 2

Assessment should include questions to determine possible causes for constipation, including eating and drinking habits, particularly fiber and fluid intake, medication use, level of physical activity, pre-existing irritable bowel syndrome or diverticular disease, and other comorbid diseases 1, 2
Elderly individuals are five times more prone to constipation, and age should be considered as a risk factor 6

Physical assessment should include abdominal examination, perineal inspection, and digital rectal examination to evaluate for signs of constipation, such as distension, abdominal masses, liver enlargement, tenderness, and increased or decreased bowel sounds 1, 4
Digital rectal examination is essential for proper evaluation of constipation and should include assessment of inner hemorrhoids, sphincter tone, tenderness, obstruction or stenosis, impacted feces, and tumor masses 1, 4

Patient-reported outcome measures (PROMs) are a preferred aspect of clinical assessment of constipation, and the Bowel Function Index (BFI) is recommended as a validated tool for assessing constipation, particularly opioid-induced constipation 1, 4, 6
Investigations are not routinely necessary for all patients with constipation, but if clinically suspected, check corrected calcium levels and thyroid function, and consider more extensive investigation for those with severe symptoms, sudden changes in number and consistency of bowel movements, or blood in the stool 1, 2