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Constipation
What's new
Updated 2024 ASCRS guidelines for the evaluation and management of chronic constipation .
Background
Overview
Definition
Constipation is a symptom-based disorder defined as fewer than 3 bowel movements per week.
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Pathophysiology
Constipation is caused by pelvic floor dysfunction, slow colonic transit, metabolic disorders (hypercalcemia, hypothyroidism), medications (opiates, CCBs, antipsychotics), neurological disorders (diabetes mellitus, Parkinson's disease, spinal cord injury), IBS, and primary colonic disorders (strictures, cancer, anal fissure, proctitis).
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Epidemiology
The overall prevalence of constipation in the US is 16%.
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Disease course
Anomalous regulation of neuromuscular components within the colon and anorectum, and disruption in the corresponding ascending and descending pathways in the brain-gut axis result in infrequent bowel movements, excessive straining, a sense of incomplete evacuation, failed or lengthy attempts to defecate, digital manipulation to evacuate stools, abdominal bloating, and hard consistency of stools.
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Prognosis and risk of recurrence
Chronic constipation decreases QoL and ability to function; however, only approximately 25% of patients consult physicians or use medications to manage associated symptoms.
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Guidelines
Key sources
The following summarized guidelines for the evaluation and management of constipation are prepared by our editorial team based on guidelines from the American Society of Colon and Rectal Surgeons (ASCRS 2024,2016), the Japanese Gastroenterological Association (JGA 2024), the American College of Gastroenterology (ACG/AGA 2023), the European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN 2023), the American Academy of Family ...
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