![]() Heavy metal poisoning (e.g., lead toxicity).Electrolyte imbalance (especially hypokalemia, hypercalcemia).Neuropathy (e.g., due to vitamin B 12 deficiency, diabetic neuropathy).Mechanical bowel obstruction resulting from, e.g.:.Secondary constipation Ĭonstipation due to a medical disorder or medicationĮtiology of secondary constipation Alterations in normal gut flora, colonic dysmotility Ī predominance of abdominal bloating, cramping, and pain associated with constipation should increase the suspicion for IBS-C.Lifestyle: poor diet, insufficient physical activity, obesity.Slow transit constipation (least common): constipation with slow colonic transit time.May be caused by inadequate rectal propulsion, increased resistance to evacuation, or other factors.Can manifest with prolonged straining, rectal discomfort, and trouble passing even soft stools.Defecatory disorders (also known as outlet obstruction or pelvic floor dyssynergia): difficulty evacuating stool once it reaches the rectum. ![]() Normal transit constipation (most common): symptoms of constipation despite normal colonic transit time.Primary constipation ( functional constipation) Ĭonstipation with no identifiable secondary cause Subtypes ![]() Acute constipation may be caused by lifestyle changes, hospitalization, immobility, or the acute onset of secondary causes of constipation. Chronic constipation is typically classified as primary or secondary depending on the etiology. EpidemiologyĬonstipation can be chronic or acute. Secondary constipation is managed by treating the identified cause.Ĭonstipation in infants, children, and adolescents is detailed separately. Refractory symptoms after an appropriate trial of empiric therapy should prompt referral to gastroenterology to evaluate for disorders of defecation or colon transit. If symptoms persist, osmotic laxatives are recommended, followed by stimulant laxatives or intestinal secretagogues if necessary. Empiric management for primary constipation begins with nonpharmacological measures (e.g., increased fiber and fluid intake, education on avoiding stool-withholding behaviors) and bulk-forming laxatives. In the absence of such signs, a clinical diagnosis of primary constipation can be established based on the Rome IV criteria for primary constipation in adults. Evaluation of constipation in adults begins with identifying red flag features for colorectal malignancy and signs of secondary constipation that may warrant specific diagnostic studies and/or immediate referral to a specialist. Secondary constipation is due to an identified cause (e.g., metabolic disorders, neurological disorders, mechanical obstruction, medication use). Primary constipation is further categorized as normal transit constipation (most common), slow transit constipation, and defecatory disorders (i.e., outlet obstruction, pelvic dyssynergia). Constipation is categorized as primary constipation (i.e., functional constipation) when no underlying medical cause or offending medication is identified. Associated features include nausea, abdominal bloating, anorexia, and, in patients with fecal impaction, paradoxical diarrhea. Constipation has been defined as < 3 bowel movements per week, but this is not a required criterion, and symptoms may include straining to defecate, the passage of hard stools, a sensation of incomplete evacuation, and/or the need for self-digitation to evacuate stool.
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