Diagnosing Constipation and Assessing Treatment

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By Janet Hannah

Chronic constipation is the cause of more than 25 million physician visits a year in the United States. Of these visits, 31 percent are to the general or family practitioner, 20 percent to an internist, and four percent to a gastroenterologist. There are more than 100,000 referrals to gastroenterologists included here. Direct healthcare costs are in the $235,000 million range. Eight hundred million dollars are spent on laxatives annually. Individuals experiencing chronic constipation have almost 14 million days of restricted activity every year. Data collected during a national survey points out that 12 percent of those with chronic constipation missed an average of 2.4 days of work or school during the previous month and 60 percent felt an impairment of some kind related to their symptoms. 

Chronic constipation is defined as a functional bowel disorder that presents with persistently difficult, infrequent or seemingly incomplete defecation and does not meet the criteria for irritable bowel disease (IBS). This definition is according to the Rome III classification. The Rome Criteria outlines symptoms and sets boundaries for frequency and duration to make it possible to provide a more accurate diagnosis of irritable bowel disease  (IBS). These guidelines were established in 1988 at the 13th International Congress of Gastroenterology meeting in Rome, Italy. The Rome Criteria are used to evaluate all patients presenting with constipation as a tool to rule out IBS.

 The Rome III diagnostic criteria for functional constipation include all of the following:

            -Straining during more than 25 percent of defecations

            -Lumpy or hard stools in more than 25 percent of defecations

            -Sensation of incomplete emptying for more than 25 percent of defecations

            -Sensation of anorectal obstruction or blockage for more than 25 percent of defecations

            -Manual maneuvers to facilitate bowel movement for more 25 percent of defecations

            -Fewer than three defecations a week

            -Loose stools rarely present without the use of laxatives

            -Insufficient criteria for IBS. Two or more of these must be included in a patient's symptoms to meet the diagnosis of constipation. These criteria must be met for the last three months with onset at least six months preceding diagnosis.

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