Constipation
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Expert Reviewers
Dr John Wyeth, Gastroenterologist and Clinical Director of Medicine, Capital & Coast DHB
Dr Simon Chin, Paediatric Gastroenterologist, Starship Hospital
Key Points
- Most cases of constipation in adults are mild and intermittent and respond to lifestyle changes such as increasing fibre in the diet, increased fluid intake and exercise
- On assessment it is important to identify any red flags that may indicate more serious disease or the need for referral
- Treatment with a laxative may be required if general lifestyle advice is not helpful
- Choice of laxative is based on the cause of constipation, symptoms, patient preferences, potential side-effects and time to effect
- Constipation is also common in children and long term use of laxatives may be required when dietary measures fail - osmotic laxatives, such as lactulose, are the preferred initial treatment
Constipation is characterised by persistent, difficult or seemingly incomplete defaecation which may be accompanied by abdominal pain or bloating. In terms of bowel frequency, definitions differ, as bowel habits vary widely between individuals, but will usually be reported to the GP as a deviation from the norm. Constipation is more common in women than men and incidence increases with age.
International consensus (Rome II) diagnostic criteria define constipation in terms of multiple symptoms (e.g. straining, hard stools) and/or a bowel movement frequency of less than three times per week (page 2). These criteria are mainly used for research purpose and are not always applicable to general practice.1
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