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Chronic Constipation

Constipation is often treated on the basis of a patient's impression that there is a disturbance in bowel function. However, the term constipation has varied meanings for different people. Stools may be too hard or too small for some, while for others defecation is too difficult or infrequent. 


The diagnosis of functional constipation should be based upon the presence of the following for at least three months (with symptom onset at least six months prior to diagnosis).

(1) Must include two or more of the following:

●Straining during more than 25 percent of defecations.

●Lumpy or hard stools (Bristol Stool Scale Form 1-2) in more than 25 percent of defecations

●Sensation of incomplete evacuation for more than 25 percent of defecations.

●Sensation of anorectal obstruction/blockage for more than 25 percent of defecations.

●Manual maneuvers to facilitate more than 25 percent of defecations (eg, digital evacuation, support of the pelvic floor).

●Fewer than three spontaneous bowel movements per week.


(2) Loose stools are rarely present without the use of laxatives

(3) There are insufficient criteria for IBS. Although patients with functional constipation may have abdominal pain and/or bloating, they are not the predominant symptoms.


Symptoms of constipation include: 

  • Having less than 3 bowel movements per week

  • Straining

  • Hard stools

  • Incomplete evacuation

  • The inability to pass stool

Chronic constipation occurs when these difficulties persist for several weeks or months. Chronic constipation can result in pain while having a bowel movement (BM) and the feeling of being unable to completely empty your bowels. 


Chronic constipation can be subclassified into four categories: normal transit, slow transit, dyssynergic defecation (DD) and slow transit-dyssynergic combination. Constipation treatment generally depends on the cause of the constipation, with diet therapy generally considered the first line of therapy. Your dietitian may work with you on any of the following dietary/ lifestyle modifications: 


- Increasing physical activity

- Increasing water intake

- Fibre manipulation 

- Supplement/ medication review and modification

- Probiotics

- Prokinetic agents


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