Diagnosis of Constipation: a Systematic Review

Seung-Jae Myung; Tae Hee Lee; Kyu Chan Huh; Suck Chei Choi; Chong-Il Sohn

doi:10.4166/kjg.2010.55.5.316

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Myung, Lee, Huh, Choi, Sohn, and The Korean Society of Neurogastroenterology and Motility: Diagnosis of Constipation: a Systematic Review

Review

Korean J Gastroenterol 2010;55(5):316-324.

Published online: 21 February 2010

DOI: https://doi.org/10.4166/kjg.2010.55.5.316

Diagnosis of Constipation: a Systematic Review

Seung-Jae Myung, M.D., Tae Hee Lee, M.D.^∗, Kyu Chan Huh, M.D.^†, Suck Chei Choi, M.D.^‡, Chong-Il Sohn, M.D.^§,; The Korean Society of Neurogastroenterology and Motility

Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, Korea

^∗Department of Internal Medicine, College of Medicine, Soonchunhyang University, Seoul, Korea

^†Department of Internal Medicine, Konyang University College of Medicine, Daejeon, Korea

^‡Department of Internal Medicine, Wonkwang University, School of Medicine, Iksan, Korea

^§Department of Medicine, Sungkyunkwan University, School of Medicine, Seoul, Korea

Correspondence to: Chong-Il Sohn, M.D. Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, 108, Pyeong-dong, Jongno-gu, Seoul 110-746, Korea Tel: +82-2-2001-2057, Fax: +82-2-2001-2610 E-mail: chongil.sohn@samsung.com

Abstract

To diagnose constipation accurately in self-reported constipated patients is very important not to miss organic disease and prevent therapeutic abuse. To investigate the etiology of functional constipation is also important to determine the therapeutic modality of constipation. In this systemic review, the clinical usefulness of symptom evaluation, diagnostic tests to rule out organic and systemic disease, and functional tests to discriminate underlying pathophysiology in the diagnosis of constipation were discussed. No specific symptoms or tests were available to predict organic versus functional constipation or differentiate slow transit constipation versus evacuation disorder. Therefore, collaborative studies are necessary to determine the pathophysiology of this disorder.

Keywords: Constipation, Diagnosis

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Fig. 1.

Flow chart for searching strategy.

Fig. 2.

MR defecography in patient with constipation. Prominent anal sphincter hypertrophy was noted (white arrow).

Table 1.

Functional Constipation according to ROME II Diagnostic Criteria

At least 12 weeks, which need not be consecutive, in the preceeding 12 months of two or more of:

1. straining in ＞1/4 defecations

2. lumpy or hard stools in 1/4 defecations

3. sensation of incomplete evacuation in ＞1/4 defecations

4. sensation of anorectal obstruction/blockade in ＞1/4 defecations

5. manual maneuvers to facilitate ＞1/4 defecations (e.g., digital evacuation, support of the pelvic floor): and/or

6. ＜3 defecations/week

Loose stools are not present, and there are insufficient criteria for IBS.

Table 2.

Functional Constipation according to ROME III Diagnostic Criteria

1. Must include 2 or more of the following

a. Straining during at least 25% of defecations

b. Lumpy or hard stools in at least 25% of defecations

c. Sensation of incomplete evacuation for at least 25% of defecations

d. Sensation of anorectal obstruction/blockage for at least 25% of defecvations

e. Manual maneuvers to facilitate at least 25% of defecations (eg, digital evacuation, support of the pelvic floor)

f. Fewer than 3 defecations per weeks

2. Loose stools or rarely present without the use of laxatives

3. There are insufficient criteria for IBS

Criteria fulfilled for the last 3 months with symptom onset at least 6 months prior to diagnosis

Table 3.

Classification of Constipated Patients

1. Constipation due to low intake

2. IBS (irritable bowel syndrome) with constipation: pain, bloating, and incomplete defecation predominate

3. STC (slow transit constipation): pelvic floor function appears to be normal, and there is evidence of slow transit

4. Rectal outlet obstruction (anismus/dyssynergia-failure of relaxation: or descending perineal syndrome and other flaccid disorders)

5. Combination of 3 and 4, often in conjunction with the feature of IBS

6. Organic constipation (mechanical obstruction or drug side effect)

7. Secondary constipation (metabolic disorders)

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