Empiric management for primary constipation begins with nonpharmacological measures (e.g., increased fiber and fluid intake, education on avoiding stool-withholding behaviors) and bulk-forming laxatives. In the absence of such signs, a clinical diagnosis of primary constipation can be established based on the Rome IV criteria for primary constipation in adults. Evaluation of constipation in adults begins with identifying red flag features for colorectal malignancy and signs of secondary constipation that may warrant specific diagnostic studies and/or immediate referral to a specialist. Secondary constipation is due to an identified cause (e.g., metabolic disorders, neurological disorders, mechanical obstruction, medication use). Primary constipation is further categorized as normal transit constipation (most common), slow transit constipation, and defecatory disorders (i.e., outlet obstruction, pelvic dyssynergia).
Constipation is categorized as primary constipation (i.e., functional constipation) when no underlying medical cause or offending medication is identified. Associated features include nausea, abdominal bloating, anorexia, and, in patients with fecal impaction, paradoxical diarrhea. Constipation has been defined as < 3 bowel movements per week, but this is not a required criterion, and symptoms may include straining to defecate, the passage of hard stools, a sensation of incomplete evacuation, and/or the need for self-digitation to evacuate stool.
0 kommentar(er)
