Chronic constipation
Abstract
Chronic constipation is a prevalent condition that severely impacts the quality of life of those affected. Several types of primary chronic constipation, which show substantial overlap, have been described, including normal-transit constipation, rectal evacuation disorders and slow-transit constipation. Diagnosis of primary chronic constipation involves a multistep process initiated by the exclusion of 'alarm' features (for example, unintentional weight loss or rectal bleeding) that might indicate organic diseases (such as polyps or tumours) and a therapeutic trial with first-line treatments such as dietary changes, lifestyle modifications and over-the-counter laxatives. If symptoms do not improve, investigations to diagnose rectal evacuation disorders and slow-transit constipation are performed, such as digital rectal examination, anorectal structure and function testing (including the balloon expulsion test, anorectal manometry or defecography) or colonic transit tests (such as the radiopaque marker test, wireless motility capsule test, scintigraphy or colonic manometry). The mainstays of treatment are diet and lifestyle interventions, pharmacological therapy and, rarely, surgery. This Primer provides an introduction to the epidemiology, pathophysiological mechanisms, diagnosis, management and quality of life associated with the commonly encountered clinical problem of chronic constipation in adults unrelated to opioid abuse.
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Bowel movements alone are not a reliable indicator for constipation severity.
“Bowel movements alone are not a reliable indicator for constipation severity, as they might be the successive outcome from laxatives without describing the sensation during defecation or the repeated passage of hard stools and straining.1,3”
From Eight-Week Supplementation With <i>Bifidobacterium lactis</i> HN019 and Functional Constipation: A Randomized Clinical Trial (2024) · cites this paper as [1]
Cites
Stool form scale as a useful guide to intestinal transit time
Lewis, S. J., & Heaton, K. W. (1997) · Scandinavian Journal of Gastroenterology · doi:10.3109/00365529709011203 · Cited by 3,244 · see citing works
The enteric nervous system and gastrointestinal innervation: integrated local and central control
Furness, J. B., Callaghan, B. P., Rivera, L. R., & Cho, H.-J. (2014) · Advances in Experimental Medicine and Biology · doi:10.1007/978-1-4939-0897-4_3 · Cited by 827 · see citing works
Epidemiology of colonic symptoms and the irritable bowel syndrome
Talley, N. J., Zinsmeister, A. R., van Dyke, C., & Melton, L. J. (1991) · Gastroenterology · doi:10.1016/0016-5085(91)90717-y · Cited by 648 · see citing works
Physical Activity Improves Symptoms in Irritable Bowel Syndrome: A Randomized Controlled Trial
Johannesson, E., Simrén, M., Strid, H., Bajor, A., & Sadik, R. (2011) · American Journal of Gastroenterology · doi:10.1038/ajg.2010.480 · Cited by 431 · see citing works
Self-citationTwo randomized trials of linaclotide for chronic constipation
Lembo, A. J., Schneier, H. A., Shiff, S. J., Kurtz, C. B., MacDougall, J. E., Jia, X. D., Shao, J. Z., Lavins, B. J., Currie, M. G., Fitch, D. A., et al. (2011) · New England Journal of Medicine · doi:10.1056/nejmoa1010863 · Cited by 373 · see citing works
Self-citationAlemi, F., Poole, D. P., Chiu, J., Schoonjans, K., Cattaruzza, F., Grider, J. R., Bunnett, N. W., & Corvera, C. U. (2013) · Gastroenterology · doi:10.1053/j.gastro.2012.09.055 · Cited by 362 · see citing works
Rao, S. S. C., Yu, S., & Fedewa, A. (2015) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.13167 · Cited by 343 · see citing works
Self-citationDiagnosis and management of chronic constipation in adults
Rao, S. S. C., Rattanakovit, K., & Patcharatrakul, T. (2016) · Nature Reviews Gastroenterology & Hepatology · doi:10.1038/nrgastro.2016.53 · Cited by 337 · see citing works
Self-citationOral bisacodyl is effective and well-tolerated in patients with chronic constipation
Kamm, M. A., Mueller–Lissner, S., Wald, A., Richter, E., Swallow, R., & Gessner, U. (2011) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2011.03.026 · Cited by 257 · see citing works
Markland, A. D., Palsson, O., Goode, P. S., Burgio, K. L., Busby-Whitehead, J., & Whitehead, W. E. (2013) · American Journal of Gastroenterology · doi:10.1038/ajg.2013.73 · Cited by 254 · see citing works
Mueller-Lissner, S., Kamm, M. A., Wald, A., Hinkel, U., Koehler, U., Richter, E., & Bubeck, J. (2010) · American Journal of Gastroenterology · doi:10.1038/ajg.2010.41 · Cited by 218 · see citing works
The proximal colonic motor response to rectal mechanical and chemical stimulation
Bampton, P. A., Dinning, P. G., Kennedy, M. L., Lubowski, D. Z., & Cook, I. J. (2002) · American Journal of Physiology-Gastrointestinal and Liver Physiology · doi:10.1152/ajpgi.00194.2001 · Cited by 215 · see citing works
Self-citationWong, R. K., Palsson, O. S., Turner, M. J., Levy, R. L., Feld, A. D., von Korff, M., & Whitehead, W. E. (2010) · American Journal of Gastroenterology · doi:10.1038/ajg.2010.200 · Cited by 204 · see citing works
Ehlers Danlos syndrome and gastrointestinal manifestations: a 20‐year experience at Mayo Clinic
Nelson, A. D., Mouchli, M. A., Valentin, N., Deyle, D., Pichurin, P., Acosta, A., & Camilleri, M. (2015) · Neurogastroenterology & Motility · doi:10.1111/nmo.12665 · Cited by 182 · see citing works
Self-citationOpioids in gastroenterology: treating adverse effects and creating therapeutic benefits
Camilleri, M., Lembo, A., & Katzka, D. A. (2017) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2017.05.014 · Cited by 176 · see citing works
Gastrointestinal involvement in the Ehlers–Danlos syndromes
Fikree, A., Chelimsky, G., Collins, H., Kovacic, K., & Aziz, Q. (2017) · American Journal of Medical Genetics Part C: Seminars in Medical Genetics · doi:10.1002/ajmg.c.31546 · Cited by 159 · see citing works
Miner, P. B., Koltun, W. D., Wiener, G. J., De La Portilla, M., Prieto, B., Shailubhai, K., Layton, M. B., Barrow, L., Magnus, L., & Griffin, P. H. (2017) · American Journal of Gastroenterology · doi:10.1038/ajg.2016.611 · Cited by 141 · see citing works
Badiali, D., Corazziari, E., Habib, F. I., Tomei, E., Bausano, G., Magrini, P., Anzini, F., & Torsoli, A. (1995) · Digestive Diseases and Sciences · doi:10.1007/bf02065421 · Cited by 127 · see citing works
Cinca, R., Chera, D., Gruss, H. ‐., & Halphen, M. (2013) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.12278 · Cited by 73 · see citing works
The Wireless Motility Capsule: a One-Stop Shop for the Evaluation of GI Motility Disorders
Saad, R. J. (2016) · Current Gastroenterology Reports · doi:10.1007/s11894-016-0489-x · Cited by 73 · see citing works
Choung, R. S., Branda, M. E., Chitkara, D., Shah, N. D., Katusic, S. K., Locke III, G. R., & Talley, N. J. (2011) · Alimentary Pharmacology & Therapeutics · doi:10.1111/j.1365-2036.2010.04513.x · Cited by 53 · see citing works
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Management of functional constipation in children and adults
Vriesman, M. H., Koppen, I. J. N., Camilleri, M., Di Lorenzo, C., & Benninga, M. A. (2020) · Nature Reviews Gastroenterology & Hepatology · doi:10.1038/s41575-019-0222-y · Cited by 457 · see citing works
Self-citationAn approach to the diagnosis and management of Rome IV functional disorders of chronic constipation
Aziz, I., Whitehead, W. E., Palsson, O. S., Törnblom, H., & Simrén, M. (2020) · Expert Review of Gastroenterology & Hepatology · doi:10.1080/17474124.2020.1708718 · Cited by 413 · see citing works
Self-citationGastrointestinal motility disorders in neurologic disease
Camilleri, M. (2021) · Journal of Clinical Investigation · doi:10.1172/jci143771 · Cited by 211 · see citing works
Self-citationMa, H., Xiong, H., Zhu, X., Ji, C., Xue, J., Li, R., Ge, B., & Cui, H. (2019) · International Journal of Biological Macromolecules · doi:10.1016/j.ijbiomac.2019.04.209 · Cited by 100 · see citing works
Chia seeds (<i>Salvia hispanica</i> L.): A therapeutic weapon in metabolic disorders
Khalid, W., Arshad, M. S., Aziz, A., Rahim, M. A., Qaisrani, T. B., Afzal, F., Ali, A., Ranjha, M. M. A. N., Khalid, M. Z., & Anjum, F. M. (2023) · Food Science & Nutrition · doi:10.1002/fsn3.3035 · Cited by 108 · see citing works
Sharma, A., Rao, S. S. C., Kearns, K., Orleck, K. D., & Waldman, S. A. (2021) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.16369 · Cited by 84 · see citing works
Self-citationCheng, J., Gao, C., Ala-Jaakkola, R., Forssten, S. D., Saarinen, M., Hibberd, A., Ouwehand, A. C., Ibarra, A., Li, D., Nordlund, A., et al. (2024) · JAMA Network Open · doi:10.1001/jamanetworkopen.2024.36888 · Cited by 17 · see citing works
- Authors
- Camilleri, M., Ford, A. C., Mawe, G. M., Dinning, P. G., Rao, S. S., Chey, W. D., Simrén, M., Lembo, A., Young-Fadok, T. M., & Chang, L.
- Affiliations
- Mayo Clinic (US)
- University of Leeds (GB)
- University of Vermont (US)
- Flinders University (AU)
- Augusta University (US)
- University of Michigan (US)
- University of Gothenburg (SE)
- Beth Israel Deaconess Medical Center (US)
- University of California, Los Angeles (US)
- Corresponding author
- Camilleri, Michael
- ORCID
- Venue
- Nature Reviews Disease Primers
- Published
- 2017-12-14
- Volume
- 3
- Issue
- 1
- Pages
- 17095-17095
- ISSN
- 2056-676X (ISSN-L)
- OpenAlex
- W4210981417
- Cited by
- 411
- References
- 21
- Citations by year
- 2026: 55 · 2025: 72 · 2024: 65 · 2023: 50 · 2022: 51 · 2021: 44 · 2020: 33 · 2019: 25 · 2018: 16
- FWCI
- 3.40
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- Nature Reviews Disease Primers (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
- Health Sciences › Medicine › Rheumatology › Pelvic floor disorders treatments
- Health Sciences › Medicine › Surgery › Congenital gastrointestinal and neural anomalies
- Keywords
- chronic constipation, slow transit constipation, anorectal manometry, defecography, laxatives, dietary and lifestyle interventions, pharmacotherapy, constipation surgery, quality of life, pathophysiology
- MeSH terms
- Age Factors, Constipation, Defecation, Humans, Rectal Diseases, Rectum, Sex Factors, Prevalence, Defecography, Digital Rectal Examination, Laxatives
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