Constipation
Encyclopedia
Constipation refers to bowel movements that are infrequent or hard to pass. Constipation is a common cause of painful defecation. Severe constipation includes obstipation (failure to pass stools or gas) and fecal impaction
(see also Bowel obstruction
).
Constipation is common; in the general population incidence
of constipation varies from 2 to 30%.
Constipation is a symptom
with many causes. These causes are of two types: obstructed defecation and colonic slow transit (or hypomobility). About 50% of patients evaluated for constipation at tertiary referral hospitals have obstructed defecation. This type of constipation has mechanical and functional causes. Causes of colonic slow transit constipation include diet
, hormone
s, side effects of medications, and heavy metal toxicity.
Treatments include changes in dietary habits, laxatives, enema
s, biofeedback
, and surgery
. Because constipation is a symptom, not a disease, effective treatment of constipation may require first determining the cause.
The Rome III criteria are widely used to diagnose chronic constipation, and are helpful in separating cases of chronic functional constipation from less-serious instances.
in toddlerhood, and soon after starting school (as in a kindergarten)
After birth, most infants pass 4-5 soft liquid bowel movements (BM) a day. Breast-fed
infants usually tend to have more BM compared to formula
-fed infants. Some breast-fed infants have a BM after each feed, whereas others have only one BM every 2–3 days. Infants who are breast-fed rarely develop constipation. By the age of two years, a child will usually have 1–2 bowel movements per day and by four years of age, a child will have one bowel movement per day.
, and obstruction by colorectal cancer
.
Constipation with no known organic cause, i.e. no medical explanation
, exhibits gender
differences in prevalence
: females are more often affected than males.
or an underlying medical condition. It is not associated with abdominal pain thus distinguishing it from irritable bowel syndrome
. It is the most common cause of constipation.
, diabetes mellitus
, cystic fibrosis
, and
celiac disease. Constipation is also common in individuals with muscular and myotonic dystrophy.
s, proctitis
, and pelvic floor dysfunction.
Constipation also has functional (neurological) causes, including anismus
, descending perineum syndrome, and Hirschsprung's disease
. In infants, Hirschsprung's disease is the most common medical disorder associated with constipation. Anismus occurs in a small minority of persons with chronic constipation or obstructed defecation.
, fiber
, and laxative
s may be useful to overcome the problem.
, abdominal pain, headaches, a feeling of fatigue and nervous exhaustion, or a sense of incomplete emptying.
Inquiring about dietary habits will often reveal a low intake of dietary fiber
, inadequate amounts of fluids, poor ambulation or immobility, or medications that are associated with constipation.
During physical examination
, scybala (manually palpable lumps of stool) may be detected on palpation of the abdomen. Rectal examination
gives an impression of the anal sphincter tone
and whether the lower rectum contains any feces or not. Rectal examination also gives information on the consistency of the stool, presence of hemorrhoid
s, admixture of blood and whether any tumors, polyp
s or abnormalities are present. Physical examination may be done manually by the physician, or by using a colonoscope. X-ray
s of the abdomen, generally only performed if bowel obstruction is suspected, may reveal extensive impacted fecal matter in the colon, and confirm or rule out other causes of similar symptoms.
Chronic constipation (symptoms present at least three days per month for more than three months) associated with abdominal discomfort is often diagnosed as irritable bowel syndrome
(IBS) when no obvious cause is found.
Colonic propagating pressure wave sequences (PSs) are responsible for discrete movements of the bowel contents and are vital for normal defecation. Deficiencies in PS frequency, amplitude and extent of propagation are all implicated in severe defecatory dysfunction (SDD). Mechanisms that can normalise these aberrant motor patterns may help rectify the problem. Recently the novel therapy of sacral nerve stimulation (SNS) has been utilized for the treatment of severe constipation.
or as supplements). The routine use of laxatives is discouraged, as having bowel movements may come to be dependent upon their use. Enemas can be used to provide a form of mechanical stimulation. However, enemas are generally useful only for stool in the rectum, not in the intestinal tract.
s may be used to improve gastrointestinal motility. A number of new agents have shown positive outcomes in chronic constipation; these include prucalopride
, and lubiprostone
.
).
and milk of magnesia have been compared with polyethylene glycol
(PEG) in children. All had similar side effects, but PEG was more effective at treating constipation. Osmotic laxatives are recommended over stimulant laxatives.
, and fecal impaction
. Straining to pass stool may lead to hemorrhoid
s. In later stages of constipation, the abdomen may become distended, hard and diffusely tender. Severe cases ("fecal impaction" or malignant constipation) may exhibit symptoms of bowel obstruction (vomiting
, very tender abdomen) and encopresis
, where soft stool from the small intestine bypasses the mass of impacted fecal matter in the colon
.
Fecal impaction
A fecal impaction is a solid, immobile bulk of human feces that can develop in the rectum as a result of chronic constipation.-Symptoms:Symptoms include chronic constipation. There can be fecal incontinence and paradoxical or overflow diarrhea as liquid stool passes around the obstruction. ...
(see also Bowel obstruction
Bowel obstruction
Bowel obstruction is a mechanical or functional obstruction of the intestines, preventing the normal transit of the products of digestion. It can occur at any level distal to the duodenum of the small intestine and is a medical emergency...
).
Constipation is common; in the general population incidence
Incidence (epidemiology)
Incidence is a measure of the risk of developing some new condition within a specified period of time. Although sometimes loosely expressed simply as the number of new cases during some time period, it is better expressed as a proportion or a rate with a denominator.Incidence proportion is the...
of constipation varies from 2 to 30%.
Constipation is a symptom
Symptom
A symptom is a departure from normal function or feeling which is noticed by a patient, indicating the presence of disease or abnormality...
with many causes. These causes are of two types: obstructed defecation and colonic slow transit (or hypomobility). About 50% of patients evaluated for constipation at tertiary referral hospitals have obstructed defecation. This type of constipation has mechanical and functional causes. Causes of colonic slow transit constipation include diet
Diet (nutrition)
In nutrition, diet is the sum of food consumed by a person or other organism. Dietary habits are the habitual decisions an individual or culture makes when choosing what foods to eat. With the word diet, it is often implied the use of specific intake of nutrition for health or weight-management...
, hormone
Hormone
A hormone is a chemical released by a cell or a gland in one part of the body that sends out messages that affect cells in other parts of the organism. Only a small amount of hormone is required to alter cell metabolism. In essence, it is a chemical messenger that transports a signal from one...
s, side effects of medications, and heavy metal toxicity.
Treatments include changes in dietary habits, laxatives, enema
Enema
An enema is the procedure of introducing liquids into the rectum and colon via the anus. The increasing volume of the liquid causes rapid expansion of the lower intestinal tract, often resulting in very uncomfortable bloating, cramping, powerful peristalsis, a feeling of extreme urgency and...
s, biofeedback
Biofeedback
Biofeedback is the process of becoming aware of various physiological functions using instruments that provide information on the activity of those same systems, with a goal of being able to manipulate them at will...
, and surgery
Surgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...
. Because constipation is a symptom, not a disease, effective treatment of constipation may require first determining the cause.
Definition
The definition of constipation includes the following:- infrequent bowel movements (typically three times or fewer per week)
- difficulty during defecation (straining during more than 25% of bowel movements or a subjective sensation of hard stools), or
- the sensation of incomplete bowel evacuation.
The Rome III criteria are widely used to diagnose chronic constipation, and are helpful in separating cases of chronic functional constipation from less-serious instances.
Children
Constipation in children usually occurs at three distinct points in time: after starting formula or processed foods (while an infant), during toilet trainingToilet training
Toilet training, or potty training, is the process of training a young child to use the toilet for urination and defecation, though training may start with a smaller toilet bowl-shaped device...
in toddlerhood, and soon after starting school (as in a kindergarten)
After birth, most infants pass 4-5 soft liquid bowel movements (BM) a day. Breast-fed
Breastfeeding
Breastfeeding is the feeding of an infant or young child with breast milk directly from female human breasts rather than from a baby bottle or other container. Babies have a sucking reflex that enables them to suck and swallow milk. It is recommended that mothers breastfeed for six months or...
infants usually tend to have more BM compared to formula
Infant formula
Infant formula is a manufactured food designed and marketed for feeding to babies and infants under 12 months of age, usually prepared for bottle-feeding or cup-feeding from powder or liquid . The U.S...
-fed infants. Some breast-fed infants have a BM after each feed, whereas others have only one BM every 2–3 days. Infants who are breast-fed rarely develop constipation. By the age of two years, a child will usually have 1–2 bowel movements per day and by four years of age, a child will have one bowel movement per day.
Causes
The causes of constipation can be divided into congenital, primary, and secondary. The most common cause is primary and not life threatening. In the elderly, causes include: insufficient dietary fiber intake, inadequate fluid intake, decreased physical activity, side effects of medications, hypothyroidismHypothyroidism
Hypothyroidism is a condition in which the thyroid gland does not make enough thyroid hormone.Iodine deficiency is the most common cause of hypothyroidism worldwide but it can be caused by other causes such as several conditions of the thyroid gland or, less commonly, the pituitary gland or...
, and obstruction by colorectal cancer
Colorectal cancer
Colorectal cancer, commonly known as bowel cancer, is a cancer caused by uncontrolled cell growth , in the colon, rectum, or vermiform appendix. Colorectal cancer is clinically distinct from anal cancer, which affects the anus....
.
Constipation with no known organic cause, i.e. no medical explanation
Explanation
An explanation is a set of statements constructed to describe a set of facts which clarifies the causes, context, and consequencesof those facts....
, exhibits gender
Gender
Gender is a range of characteristics used to distinguish between males and females, particularly in the cases of men and women and the masculine and feminine attributes assigned to them. Depending on the context, the discriminating characteristics vary from sex to social role to gender identity...
differences in prevalence
Prevalence
In epidemiology, the prevalence of a health-related state in a statistical population is defined as the total number of cases of the risk factor in the population at a given time, or the total number of cases in the population, divided by the number of individuals in the population...
: females are more often affected than males.
Primary
Primary or functional constipation is ongoing symptoms for greater than six months not due to any underlying cause such as medication side effectsSide Effects
Side Effects is an anthology of 17 comical short stories written by Woody Allen between 1975 and 1980, all but one of which were previously published in, variously, The New Republic, The New York Times, The New Yorker, and The Kenyon Review. It includes Allen's 1978 O...
or an underlying medical condition. It is not associated with abdominal pain thus distinguishing it from irritable bowel syndrome
Irritable bowel syndrome
Irritable bowel syndrome is a diagnosis of exclusion. It is a functional bowel disorder characterized by chronic abdominal pain, discomfort, bloating, and alteration of bowel habits in the absence of any detectable organic cause. In some cases, the symptoms are relieved by bowel movements...
. It is the most common cause of constipation.
Diet
Constipation can be caused or exacerbated by a low fiber diet, low liquid intake, or dieting.Medication
Many medications have constipation as a side effect. Some include (but are not limited to); opioids (e.g. common pain killers), diuretics, antidepressants, antihistamines, antispasmodics, anticonvulsants, and aluminum antacidsMetabolic & muscular
Metabolic and endocrine problems which may lead to constipation include: hypercalcemia, hypothyroidismHypothyroidism
Hypothyroidism is a condition in which the thyroid gland does not make enough thyroid hormone.Iodine deficiency is the most common cause of hypothyroidism worldwide but it can be caused by other causes such as several conditions of the thyroid gland or, less commonly, the pituitary gland or...
, diabetes mellitus
Diabetes mellitus
Diabetes mellitus, often simply referred to as diabetes, is a group of metabolic diseases in which a person has high blood sugar, either because the body does not produce enough insulin, or because cells do not respond to the insulin that is produced...
, cystic fibrosis
Cystic fibrosis
Cystic fibrosis is a recessive genetic disease affecting most critically the lungs, and also the pancreas, liver, and intestine...
, and
celiac disease. Constipation is also common in individuals with muscular and myotonic dystrophy.
Structural and functional abnormalities
Constipation has a number of structural (mechanical, morphological, anatomical) causes, including: spinal cord lesions, Parkinsons, colon cancer, anal fissureAnal fissure
An anal fissure is a break or tear in the skin of the anal canal. Anal fissures may be noticed by bright red anal bleeding on the toilet paper, sometimes in the toilet. If acute they may cause severe periodic pain after defecation but with chronic fissures pain intensity is often less...
s, proctitis
Proctitis
Proctitis is an inflammation of the anus and the lining of the rectum, affecting only the last 6 inches of the rectum.-Overview:Symptoms are ineffectual straining to empty the bowels, diarrhea, rectal bleeding and possible discharge, a feeling of not having adequately emptied the bowels,...
, and pelvic floor dysfunction.
Constipation also has functional (neurological) causes, including anismus
Anismus
Anismus is a malfunction of the external anal sphincter and puborectalis muscle during defecation. Normal defecation involves relaxation of both of these muscles...
, descending perineum syndrome, and Hirschsprung's disease
Hirschsprung's disease
Hirschsprung's disease , or congenital aganglionic megacolon is a serious medical problem where the enteric nervous system is missing from the end of the bowel. The enteric nervous system is a complex network of neurons and glia that controls most aspects of intestinal function...
. In infants, Hirschsprung's disease is the most common medical disorder associated with constipation. Anismus occurs in a small minority of persons with chronic constipation or obstructed defecation.
Psychological
Voluntary withholding of the stool is a common cause of constipation. The choice to withhold can be due to factors such as fear of pain, fear of public restrooms, or laziness. When a child holds in the stool a combination of encouragement, fluidsDrink
A drink, or beverage, is a liquid which is specifically prepared for human consumption. In addition to fulfilling a basic human need, beverages form part of the culture of human society.-Water:...
, fiber
Dietary fiber
Dietary fiber, dietary fibre, or sometimes roughage is the indigestible portion of plant foods having two main components:* soluble fiber that is readily fermented in the colon into gases and physiologically active byproducts, and* insoluble fiber that is metabolically inert, absorbing water as it...
, and laxative
Laxative
Laxatives are foods, compounds, or drugs taken to induce bowel movements or to loosen the stool, most often taken to treat constipation. Certain stimulant, lubricant, and saline laxatives are used to evacuate the colon for rectal and/or bowel examinations, and may be supplemented by enemas under...
s may be useful to overcome the problem.
Diagnosis
The diagnosis is essentially made from the patient's description of the symptoms. Bowel movements that are difficult to pass, very firm, or made up of small hard pellets (like those excreted by rabbits) qualify as constipation, even if they occur every day. Other symptoms related to constipation can include bloating, distensionAbdominal distension
Abdominal distension is a sensation of elevated abdominal pressure and volume. It is estimated that close to 25% of the US population has some degree of abdominal distension on a regular basis. Some describe it as belching, others claim they feel nausea and yet others say they pass excessive gas...
, abdominal pain, headaches, a feeling of fatigue and nervous exhaustion, or a sense of incomplete emptying.
Inquiring about dietary habits will often reveal a low intake of dietary fiber
Dietary fiber
Dietary fiber, dietary fibre, or sometimes roughage is the indigestible portion of plant foods having two main components:* soluble fiber that is readily fermented in the colon into gases and physiologically active byproducts, and* insoluble fiber that is metabolically inert, absorbing water as it...
, inadequate amounts of fluids, poor ambulation or immobility, or medications that are associated with constipation.
During physical examination
Physical examination
Physical examination or clinical examination is the process by which a doctor investigates the body of a patient for signs of disease. It generally follows the taking of the medical history — an account of the symptoms as experienced by the patient...
, scybala (manually palpable lumps of stool) may be detected on palpation of the abdomen. Rectal examination
Rectal examination
A rectal examination or rectal exam is an internal examination of the rectum such as by a physician or other healthcare professional.-Procedure:...
gives an impression of the anal sphincter tone
Muscle tone
In physiology, medicine, and anatomy, muscle tone is the continuous and passive partial contraction of the muscles, or the muscle’s resistance to passive stretch during resting state. It helps maintain posture, and it declines during REM sleep.-Purpose:Unconscious nerve impulses maintain the...
and whether the lower rectum contains any feces or not. Rectal examination also gives information on the consistency of the stool, presence of hemorrhoid
Hemorrhoid
Hemorrhoids or haemorrhoids , are vascular structures in the anal canal which help with stool control. They become pathological or piles when swollen or inflamed. In their physiological state they act as a cushion composed of arterio-venous channels and connective tissue that aid the passage of...
s, admixture of blood and whether any tumors, polyp
Polyp
A polyp in zoology is one of two forms found in the phylum Cnidaria, the other being the medusa. Polyps are approximately cylindrical in shape and elongated at the axis of the body...
s or abnormalities are present. Physical examination may be done manually by the physician, or by using a colonoscope. X-ray
X-ray
X-radiation is a form of electromagnetic radiation. X-rays have a wavelength in the range of 0.01 to 10 nanometers, corresponding to frequencies in the range 30 petahertz to 30 exahertz and energies in the range 120 eV to 120 keV. They are shorter in wavelength than UV rays and longer than gamma...
s of the abdomen, generally only performed if bowel obstruction is suspected, may reveal extensive impacted fecal matter in the colon, and confirm or rule out other causes of similar symptoms.
Chronic constipation (symptoms present at least three days per month for more than three months) associated with abdominal discomfort is often diagnosed as irritable bowel syndrome
Irritable bowel syndrome
Irritable bowel syndrome is a diagnosis of exclusion. It is a functional bowel disorder characterized by chronic abdominal pain, discomfort, bloating, and alteration of bowel habits in the absence of any detectable organic cause. In some cases, the symptoms are relieved by bowel movements...
(IBS) when no obvious cause is found.
Colonic propagating pressure wave sequences (PSs) are responsible for discrete movements of the bowel contents and are vital for normal defecation. Deficiencies in PS frequency, amplitude and extent of propagation are all implicated in severe defecatory dysfunction (SDD). Mechanisms that can normalise these aberrant motor patterns may help rectify the problem. Recently the novel therapy of sacral nerve stimulation (SNS) has been utilized for the treatment of severe constipation.
Criteria
The Rome II Criteria for constipation require at least two of the following symptoms for 12 weeks or more over the period of a year:- Straining with more than one-fourth of defecationDefecationDefecation is the final act of digestion by which organisms eliminate solid, semisolid or liquid waste material from the digestive tract via the anus. Waves of muscular contraction known as peristalsis in the walls of the colon move fecal matter through the digestive tract towards the rectum...
s - Hard stoolStoolStool may refer to:*Stool , a type of seat without back or arm rests** A bar stool** A footstool** A Stool , an alphabetic uniliteral sign of ancient Egypt** In West Africa, a throne* A flush toilet, in some dialects...
with more than one-fourth of defecationDefecationDefecation is the final act of digestion by which organisms eliminate solid, semisolid or liquid waste material from the digestive tract via the anus. Waves of muscular contraction known as peristalsis in the walls of the colon move fecal matter through the digestive tract towards the rectum...
s - Feeling of incomplete evacuation with more than one-fourth of defecationDefecationDefecation is the final act of digestion by which organisms eliminate solid, semisolid or liquid waste material from the digestive tract via the anus. Waves of muscular contraction known as peristalsis in the walls of the colon move fecal matter through the digestive tract towards the rectum...
s - Sensation of anorectalAnorectalNot to be confused with anorexia.Anorectal anomalies are medical problems affecting the structure of the anus and rectum. A person with an anorectal problem would have some sort of deformative feature of the anus or rectum, collectively known as an anorectal malformation.Examples of anorectal...
obstruction with more than one-fourth of defecationDefecationDefecation is the final act of digestion by which organisms eliminate solid, semisolid or liquid waste material from the digestive tract via the anus. Waves of muscular contraction known as peristalsis in the walls of the colon move fecal matter through the digestive tract towards the rectum...
s - Manual maneuvers to facilitate more than one-fourth of defecationDefecationDefecation is the final act of digestion by which organisms eliminate solid, semisolid or liquid waste material from the digestive tract via the anus. Waves of muscular contraction known as peristalsis in the walls of the colon move fecal matter through the digestive tract towards the rectum...
s - Fewer than three bowel movements per week
- Insufficient criteria for irritable bowel syndromeIrritable bowel syndromeIrritable bowel syndrome is a diagnosis of exclusion. It is a functional bowel disorder characterized by chronic abdominal pain, discomfort, bloating, and alteration of bowel habits in the absence of any detectable organic cause. In some cases, the symptoms are relieved by bowel movements...
Prevention
Constipation is usually easier to prevent than to treat. Following the relief of constipation, maintenance with adequate exercise, fluid intake, and high fiber diet is recommended. Children benefit from scheduled toilet breaks, once early in the morning and 30 minutes after meals.Treatment
The main treatment of constipation involves the increased intake of water, and fiber (either dietaryDietary fiber
Dietary fiber, dietary fibre, or sometimes roughage is the indigestible portion of plant foods having two main components:* soluble fiber that is readily fermented in the colon into gases and physiologically active byproducts, and* insoluble fiber that is metabolically inert, absorbing water as it...
or as supplements). The routine use of laxatives is discouraged, as having bowel movements may come to be dependent upon their use. Enemas can be used to provide a form of mechanical stimulation. However, enemas are generally useful only for stool in the rectum, not in the intestinal tract.
Laxatives
If laxatives are used, milk of magnesia is recommended as a first-line agent due to its low cost and safety. Stimulants should only be used if this is not effective. In cases of chronic constipation, prokineticProkinetic agent
A gastroprokinetic agent, gastrokinetic, or prokinetic, is a type of drug which enhances gastrointestinal motility by increasing the frequency of contractions in the small intestine or making them stronger, but without disrupting their rhythm...
s may be used to improve gastrointestinal motility. A number of new agents have shown positive outcomes in chronic constipation; these include prucalopride
Prucalopride
Prucalopride is a drug acting as a selective, high affinity 5-HT4 receptor agonist which targets the impaired motility associated with chronic constipation, thus normalising bowel movements...
, and lubiprostone
Lubiprostone
Lubiprostone is a medication used in the management of chronic idiopathic constipation and irritable bowel syndrome. It was approved by the U.S...
.
Physical intervention
Constipation that resists the above measures may require physical intervention such as manual disimpaction (the physical removal of impacted stool using the hands; see Fecal impactionFecal impaction
A fecal impaction is a solid, immobile bulk of human feces that can develop in the rectum as a result of chronic constipation.-Symptoms:Symptoms include chronic constipation. There can be fecal incontinence and paradoxical or overflow diarrhea as liquid stool passes around the obstruction. ...
).
Pediatric
LactuloseLactulose
Lactulose is a synthetic, non-digestible sugar used in the treatment of chronic constipation and hepatic encephalopathy, a complication of liver disease. It is a disaccharide formed from one molecule each of the simple sugars fructose and galactose...
and milk of magnesia have been compared with polyethylene glycol
Polyethylene glycol
Polyethylene glycol is a polyether compound with many applications from industrial manufacturing to medicine. It has also been known as polyethylene oxide or polyoxyethylene , depending on its molecular weight, and under the tradename Carbowax.-Available forms:PEG, PEO, or POE refers to an...
(PEG) in children. All had similar side effects, but PEG was more effective at treating constipation. Osmotic laxatives are recommended over stimulant laxatives.
Prognosis
Complications that can arise from constipation include hemorrhoids, anal fissures, rectal prolapseRectal prolapse
Rectal prolapse normally describes a medical condition wherein the walls of the rectum protrude through the anus and hence become visible outside the body.-Types:There are three chief conditions which come under the title rectal prolapse:...
, and fecal impaction
Fecal impaction
A fecal impaction is a solid, immobile bulk of human feces that can develop in the rectum as a result of chronic constipation.-Symptoms:Symptoms include chronic constipation. There can be fecal incontinence and paradoxical or overflow diarrhea as liquid stool passes around the obstruction. ...
. Straining to pass stool may lead to hemorrhoid
Hemorrhoid
Hemorrhoids or haemorrhoids , are vascular structures in the anal canal which help with stool control. They become pathological or piles when swollen or inflamed. In their physiological state they act as a cushion composed of arterio-venous channels and connective tissue that aid the passage of...
s. In later stages of constipation, the abdomen may become distended, hard and diffusely tender. Severe cases ("fecal impaction" or malignant constipation) may exhibit symptoms of bowel obstruction (vomiting
Vomiting
Vomiting is the forceful expulsion of the contents of one's stomach through the mouth and sometimes the nose...
, very tender abdomen) and encopresis
Encopresis
Encopresis is involuntary fecal soiling in adults and children who have usually already been toilet trained. Persons with encopresis often leak stool into their undergarments.-Prevalence:The estimated prevalence of encopresis in four-year-olds is between one and three percent...
, where soft stool from the small intestine bypasses the mass of impacted fecal matter in the colon
Colon (anatomy)
The colon is the last part of the digestive system in most vertebrates; it extracts water and salt from solid wastes before they are eliminated from the body, and is the site in which flora-aided fermentation of unabsorbed material occurs. Unlike the small intestine, the colon does not play a...
.
Epidemiology
Constipation is the most common digestive complaint in the United States as per survey data. Depending on the definition employed, it occurs in 2% to 20% of the population. It is more common in women, the elderly and children. The reasons it occurs more frequently in the elderly is felt to be due to an increasing number of health problems as humans age and decreased physical activity.- 12% of the population worldwide reports having constipation.
- Chronic constipation accounts for 3% of all visits annually to pediatric outpatient clinics
- Constipation-related healthcare costs total $6.9 billion in the US annually.
- More than four million Americans have frequent constipation, accounting for 2.5 million physician visits a year.
- Around $725 million is spent on laxative products each year in America.
External links
- Constipation - Introduction (UK NHS site)
- Constipation Guideline - the World Gastroenterology Organisation (WGO)
- Constipation treatment guide - Canadian Society for Gastrointestinal Endoscopy