Chronic constipation affects an estimated 10-20% of the population. It significantly impairs in quality of life and has a socio-economic impact.
Constipation is a symptom rather than a disease, therefore exploring the cause of the symptom is crucial in management. This requires an understanding of the pathophysiology of constipation and how this influences symptoms.
The most useful summary is that constipation is defined as at least three months of unsatisfactory defecation characterised by infrequent stools, difficult stool passage, or both.
Although healthcare professionals tend to focus on frequency, patients are more troubled by other symptoms, such as straining, incomplete evacuation, hard stools and bloating.
There is a clinical overlap between chronic constipation and constipation-predominant irritable bowel syndrome – abdominal pain temporally related to bowel infrequency is a key feature of the latter.1
Diagnosis requires differentiating a primary cause (due to a gut disorder) from a secondary one (due to an extra-intestinal one). The former requires long-term symptom control, while the latter may have a definitive solution.
Epidemiology
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