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JAMA Clinical Guidelines Synopsis
January 12, 2016

Evaluation and Treatment of Patients With Constipation

Author Affiliations
  • 1University of Chicago, Chicago, Illinois
JAMA. 2016;315(2):192-193. doi:10.1001/jama.2015.16995

Constipation occurs in approximately 12% to 19% of the population1 and increases with age, especially after 60 years. Constipation is a common problem in outpatient practices and a frequent reason for admission to the hospital2 and thus is associated with significant adverse effects on quality of life and health care expenditures. Chronic constipation is defined as presence for more than 3 to 6 months of 2 or more of the following symptoms: decreased stool frequency, straining, hard stools, sensation of incomplete emptying or anorectal blockage, requirement for manual maneuvers to pass stool, and rare loose stools in the absence of laxative use.3 Unlike chronic constipation, constipation-predominant irritable bowel syndrome (IBS-C) presents as recurrent abdominal pain or discomfort associated with hard or infrequent stools or relieved by defecation. There are 3 categories of chronic constipation: disorders of defecation (dyssynergy), STC, and NTC. Defecatory disorders can occur with either STC or NTC. Most patients can be treated without extensive testing. Systemic conditions and medications that aggravate constipation should be addressed.4 Diet, fluids, nonprescription medications, fiber supplements, osmotic agents, and stimulant cathartics can be effective but may challenge adherence. Refractory cases require specific testing and specialist referral. New drugs with novel mechanisms of action have shown promise.5,6 Biofeedback typically is recommended for defecatory disorders. Colorectal surgery is a last resort.