Constipation: A guide to assessment and treatment

Large numbers of adults attend GP practices seeking advice on constipation, and GPs in England spend around £92 million a year on laxative prescriptions.^{1, 2} In an average month, 500 000 litres of lactulose are prescribed by GPs in England.³ Constipation is defined as: ‘Defecation that is unsatisfactory, because of infrequent stools, difficult stool passage or seemingly incomplete defecation.’ ⁴

Constipation is a subjective symptom based on a person’s expectations of bowel frequency, stool volume, consistency and ease in passing stool. The Rome diagnostic criteria (Table 1) can help diagnose constipation.⁵

Constipation can be acute or chronic. Chronic constipation affects 14% of adults worldwide. Women are twice as likely to seek treatment for it as men, and women of childbearing age are more likely than older women to seek treatment. It is thought that oestrogen and progesterone the female sex hormones make the colon more sluggish.⁶ There is a higher prevalence in people of lower socioeconomic status.⁷