The DOI matches its Crossref record; 170 of the 170 references it cites were found in a registry or an index.
Mechanisms, Evaluation, and Management of Chronic Constipation
Open accessAbstract
With a worldwide prevalence of 15%, chronic constipation is one of the most frequent gastrointestinal diagnoses made in ambulatory medicine clinics, and is a common source cause for referrals to gastroenterologists and colorectal surgeons in the United States. Symptoms vary among patients; straining, incomplete evacuation, and a sense of anorectal blockage are just as important as decreased stool frequency. Chronic constipation is either a primary disorder (such as normal transit, slow transit, or defecatory disorders) or a secondary one (due to medications or, in rare cases, anatomic alterations). Colonic sensorimotor disturbances and pelvic floor dysfunction (such as defecatory disorders) are the most widely recognized pathogenic mechanisms. Guided by efficacy and cost, management of constipation should begin with dietary fiber supplementation and stimulant and/or osmotic laxatives, as appropriate, followed, if necessary, by intestinal secretagogues and/or prokinetic agents. Peripherally acting μ-opiate antagonists are another option for opioid-induced constipation. Anorectal tests to evaluate for defecatory disorders should be performed in patients who do not respond to over-the-counter agents. Colonic transit, followed if necessary with assessment of colonic motility with manometry and/or a barostat, can identify colonic dysmotility. Defecatory disorders often respond to biofeedback therapy. For specific patients, slow-transit constipation may necessitate a colectomy. No studies have compared inexpensive laxatives with newer drugs with different mechanisms. We review the mechanisms, evaluation, and management of chronic constipation. We discuss the importance of meticulous analyses of patient history and physical examination, advantages and disadvantages of diagnostic testing, guidance for individualized treatment, and management of medically refractory patients.
Overview
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“For prucalopride, a selective agonist of serotonin 5-HT 4 receptors, the recommended dose is 2 mg once daily in adults and 1 mg daily in individuals with severe renal impairment (ie, creatinine clearance <30 mL/min). 80”
From American Gastroenterological Association-American College of Gastroenterology Clinical Practice Guideline: Pharmacological Management of Chronic Idiopathic Constipation (2023) · cites this paper as [80]
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Citations
Cites
Lacy, B. E., Mearin, F., Chang, L., Chey, W. D., Lembo, A. J., Simren, M., & Spiller, R. (2016) · Gastroenterology · doi:10.1053/j.gastro.2016.02.031 · Cited by 2,866
Self-citationPeery, A. F., Crockett, S. D., Murphy, C. C., Lund, J. L., Dellon, E. S., Williams, J. L., Jensen, E. T., Shaheen, N. J., Barritt, A. S., Lieber, S. R., et al. (2019) · Gastroenterology · doi:10.1053/j.gastro.2018.08.063 · Cited by 1,619
Epidemiology of constipation in children and adults: A systematic review
Mugie, S. M., Benninga, M. A., & Lorenzo, C. D. (2011) · Best Practice & Research Clinical Gastroenterology · doi:10.1016/j.bpg.2010.12.010 · Cited by 945
Simplified assessment of segmental colonic transit
Metcalf, A. M., Phillips, S. F., Zinsmeister, A. R., MacCarty, R. L., Beart, R. W., & Wolff, B. G. (1987) · Gastroenterology · doi:10.1016/0016-5085(87)90837-7 · Cited by 928
American Gastroenterological Association Technical Review on Constipation
Bharucha, A. E., Pembérton, J. H., & Locke, G. R. (2012) · Gastroenterology · doi:10.1053/j.gastro.2012.10.028 · Cited by 924
Self-citationFunctional anorectal disorders.
Bharucha, A., Wald, A., Enck, P., & Rao, S. S. C. (2006) · Gastroenterology · doi:10.1053/j.gastro.2005.11.064 · Cited by 770
Self-citationDefecography in normal volunteers: results and implications.
Shorvon, P. J., McHugh, S., Diamant, N. E., Somers, S., & Stevenson, G. W. (1989) · Gut · doi:10.1136/gut.30.12.1737 · Cited by 756
Ford, A. C., Quigley, E. M. M., Lacy, B. E., Lembo, A. J., Saito, Y. A., Schiller, L. R., Soffer, E. E., Spiegel, B. M. R., & Moayyedi, P. (2014) · American Journal of Gastroenterology · doi:10.1038/ajg.2014.202 · Cited by 747
Self-citationMyths and Misconceptions About Chronic Constipation
Müller-Lissner, S. A., Kamm, M. A., Scarpignato, C., & Wald, A. M. (2005) · The American Journal of Gastroenterology · doi:10.1111/j.1572-0241.2005.40885.x · Cited by 616
Sphincter denervation in anorectal incontinence and rectal prolapse.
Parks, A. G., Swash, M., & Urich, H. (1977) · Gut · doi:10.1136/gut.18.8.656 · Cited by 552
Flagged first, then by citations
Research works printed but not linked: 1
- Diamant, 1999, American Gastroenterological Association medical position statement on anorectal testing techniques, Gastroenterology, 116, 732, 10.1016/S0016-5085(99)70194-0 · DOI
Cited by
Sorted by citations
Chang, L., Chey, W. D., Imdad, A., Almario, C. V., Bharucha, A. E., Diem, S., Greer, K. B., Hanson, B., Harris, L. A., Ko, C., et al. (2023) · Gastroenterology · doi:10.1053/j.gastro.2023.03.214 · Cited by 185
Self-citationACG Clinical Guidelines: Management of Benign Anorectal Disorders
Wald, A. M., Bharucha, A. E., Limketkai, B. N., Malcolm, A., Remes-Troche, J. M., Whitehead, W. E., & Zutshi, M. (2021) · The American Journal of Gastroenterology · doi:10.14309/ajg.0000000000001507 · Cited by 166
Self-citationThe enteric nervous system in gastrointestinal disease etiology
Holland, A. M., Bon‐Frauches, A. C., Keszthelyi, D., Melotte, V., & Boesmans, W. (2021) · Cellular and Molecular Life Sciences · doi:10.1007/s00018-021-03812-y · Cited by 172
“This is also the case for slow transit constipation, defined by reduced and infrequent intestinal transit, sensation of anorectal obstruction and solid fecal content [94].”
BackgroundPan, R., Wang, L., Xu, X., Chen, Y., Wang, H., Wang, G., Zhao, J., & Chen, W. (2022) · Nutrients · doi:10.3390/nu14183704 · Cited by 149
“However, the aetiology and pathophysiology of CC are largely unknown [2].”
BackgroundUnderstanding the physiology of human defaecation and disorders of continence and evacuation
Heitmann, P. T., Vollebregt, P. F., Knowles, C. H., Lunniss, P. J., Dinning, P. G., & Scott, S. M. (2021) · Nature Reviews Gastroenterology & Hepatology · doi:10.1038/s41575-021-00487-5 · Cited by 156
Sex- and Gender-Related Differences in Common Functional Gastroenterologic Disorders
Narayanan, S. P., Anderson, B., & Bharucha, A. E. (2021) · Mayo Clinic Proceedings · doi:10.1016/j.mayocp.2020.10.004 · Cited by 131
Self-citationZhang, X., Yang, H., Zheng, J., Jiang, N., Sun, G., Bao, X., Lin, A., & Liu, H. (2020) · Carbohydrate Polymers · doi:10.1016/j.carbpol.2020.117218 · Cited by 121
Bharucha, A. E., Knowles, C. H., Mack, I., Malcolm, A., Oblizajek, N. R., Rao, S. S. C., Scott, S. M., Shin, A., & Enck, P. (2022) · Nature Reviews Disease Primers · doi:10.1038/s41572-022-00381-7 · Cited by 117
Self-citationChronic Constipation: Is a Nutritional Approach Reasonable?
Bellini, M., Tonarelli, S., Barracca, F., Rettura, F., Pancetti, A., Ceccarelli, L., Ricchiuti, A., Costa, F., de Bortoli, N., Marchi, S., et al. (2021) · Nutrients · doi:10.3390/nu13103386 · Cited by 102
Current Overview on Clinical Management of Chronic Constipation
Włodarczyk, J., Waśniewska, A., Fichna, J., Dziki, A. J., Dziki, Ł. A., & Włodarczyk, M. (2021) · Journal of Clinical Medicine · doi:10.3390/jcm10081738 · Cited by 107
“On the other hand, colonoscopy is recommended for patients, who are at the age appropriate for colon-cancer screening, or with alarm signs [7,23,34].”
BackgroundInfluentialRoles of Gut Microbiota and Metabolites in Pathogenesis of Functional Constipation
Wang, J.-K., & Yao, S.-K. (2021) · Evidence-Based Complementary and Alternative Medicine · doi:10.1155/2021/5560310 · Cited by 98
Bifidobacterium spp. as functional foods: A review of current status, challenges, and strategies
He, B., Xiong, Y., Hu, T., Zong, M., & Wu, H. (2022) · Critical Reviews in Food Science and Nutrition · doi:10.1080/10408398.2022.2054934 · Cited by 101
“Constipation is a common gastrointestinal dysfunction disease with symptoms of hard, dry, or lumpy stools and difficult defecation, affecting around 11-20% of the adult population yearly (Bharucha and Lacy 2020).”
BackgroundGlobal prevalence of constipation in older adults: a systematic review and meta-analysis
Salari, N., Ghasemianrad, M., Ammari‐Allahyari, M., Rasoulpoor, S., Shohaimi, S., & Mohammadi, M. (2023) · Wiener klinische Wochenschrift · doi:10.1007/s00508-023-02156-w · Cited by 92
“5% was attributed to adults between 60 and 110 years old [11].”
BackgroundBharucha, A. E., Basilisco, G., Malcolm, A., Lee, T. H., Hoy, M. B., Scott, S. M., & Rao, S. S. C. (2022) · Neurogastroenterology & Motility · doi:10.1111/nmo.14335 · Cited by 86
Self-citationAction Mode of Gut Motility, Fluid and Electrolyte Transport in Chronic Constipation
Zhao, Q., Chen, Y., Xu, D., Yue, S., Fu, R., Yang, J., Xing, L.-M., & Tang, Y. (2021) · Frontiers in Pharmacology · doi:10.3389/fphar.2021.630249 · Cited by 87
The gut microbiome in disorders of gut–brain interaction
Kraïmi, N., Ross, T., Pujo, J., & Palma, G. D. (2024) · Gut Microbes · doi:10.1080/19490976.2024.2360233 · Cited by 93
Yang, Z., Ye, S., Xu, Z., Su, H., Tian, X., Han, B. R., Shen, B., Liao, Q., Xie, Z., & Hong, Y. (2021) · Food Research International · doi:10.1016/j.foodres.2021.110569 · Cited by 74
Constipation and Fecal Incontinence in the Elderly
Deb, B., Prichard, D. O., & Bharucha, A. E. (2020) · Current Gastroenterology Reports · doi:10.1007/s11894-020-00791-1 · Cited by 81
Self-citationLiu, Q., Kang, Y., & Jin, Y. (2022) · BMC Public Health · doi:10.1186/s12889-022-14360-w · Cited by 69
“Dietary adjustment is considered as an effective strategy to alleviate or treat this symptom [8].”
BackgroundPotential role of fecal microbiota in patients with constipation
Tian, Y., Zuo, L., Guo, Q., Li, J., Hu, Z., Zhao, K., Li, C., Li, X., Zhou, J., Zhou, Y., et al. (2020) · Therapeutic Advances in Gastroenterology · doi:10.1177/1756284820968423 · Cited by 68
Antipsychotic-Induced Constipation: A Review of the Pathogenesis, Clinical Diagnosis, and Treatment
Xu, Y., Amdanee, N., & Zhang, X. (2021) · CNS Drugs · doi:10.1007/s40263-021-00859-0 · Cited by 73
Morishita, D., Tomita, T., Mori, S., Kimura, T., Oshima, T., Fukui, H., & Miwa, H. (2021) · American Journal of Gastroenterology · doi:10.14309/ajg.0000000000000942 · Cited by 65
Medical Management of Constipation in Elderly Patients: Systematic Review
Kang, S. J., Cho, Y. S., Lee, T. H., Kim, S., Ryu, H. S., Kim, J., Park, S., Lee, Y. J., & Shin, J. E. (2021) · Journal of Neurogastroenterology and Motility · doi:10.5056/jnm20210 · Cited by 69
“41 A study of lubiprostone in the elderly can be found in 1 conference abstract.”
Blackett, J. W., Gautam, M., Mishra, R., Oblizajek, N. R., Ramu, S. K., Bailey, K. R., & Bharucha, A. E. (2022) · Gastroenterology · doi:10.1053/j.gastro.2022.08.034 · Cited by 64
Self-citationParkinson’s Disease and the Gut: Symptoms, Nutrition, and Microbiota
Yemula, N., Dietrich, C. M., Dostal, V., & Hornberger, M. (2021) · Journal of Parkinson s Disease · doi:10.3233/jpd-212707 · Cited by 71
“Intestinal complications arising from constipation such as sigmoid volvulus, bowel perforation, and asymptomatic megacolon may also occur [57].”
BackgroundArco, S., Saldaña, E., Serra‐Prat, M., Palomera, E., Ribas, Y., Font, S. B., Clavé, P., & Mundet, L. (2021) · Gerontology · doi:10.1159/000517212 · Cited by 62
Comparison of Different Soluble Dietary Fibers during the In Vitro Fermentation Process
Bai, J., Li, Y., Li, T., Zhang, W., Fan, M., Zhang, K., Qian, H., Zhang, H., Qi, X., & Wang, L. (2021) · Journal of Agricultural and Food Chemistry · doi:10.1021/acs.jafc.1c00237 · Cited by 62
Ma, Y., Cheng, J., Liu, L., Chen, K., Fang, Y., Wang, G., Zhu, J., & Chen, L. (2020) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2020.103783 · Cited by 60
Liang, J., Zhao, Y., Xi, Y., Xiang, C., Yong, C., Huo, J., Zou, H., Hou, Y., Pan, Y., Wu, M., et al. (2022) · Nutrients · doi:10.3390/nu14235013 · Cited by 66
Targeting intestinal flora and its metabolism to explore the laxative effects of rhubarb
Yang, L., Wan, Y., Li, W., Liu, C., Li, H., Dong, Z., Zhu, K., Jiang, S., Shang, E., Qian, D., et al. (2022) · Applied Microbiology and Biotechnology · doi:10.1007/s00253-022-11813-5 · Cited by 59
“Complications of constipation include hemorrhoids, anal fissures, diverticulitis, and impaction of stool (Bharucha and Lacy 2020).”
BackgroundAraújo, M. M., & Botelho, P. B. (2022) · Frontiers in Nutrition · doi:10.3389/fnut.2022.935830 · Cited by 58
Ma, T., Yang, N., Xie, Y., Li, Y., Xiao, Q., Li, Q., Jin, H., Zheng, L., Sun, Z., Zuo, K., et al. (2023) · Pharmacological Research · doi:10.1016/j.phrs.2023.106755 · Cited by 66
Corsetti, M., Landes, S., & Lange, R. (2021) · Neurogastroenterology & Motility · doi:10.1111/nmo.14123 · Cited by 53
Staller, K. D., Olén, O., Söderling, J. K., Roelstraete, B., Törnblom, H., Song, M., & Ludvigsson, J. F. (2021) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2021.10.024 · Cited by 51
Idiopathic Slow Transit Constipation: Pathophysiology, Diagnosis, and Management
Vlismas, L. J., Wu, W. K. K., & Ho, V. (2024) · Medicina · doi:10.3390/medicina60010108 · Cited by 55
“Propagating motor patterns result in powerful contractions which propel contents from the right to left colon towards the anus, resulting in mass movements, which are the main type of propulsive motility of the colon [4,7,12,18].”
BackgroundInfluentialNeurogenic Bowel and Management after Spinal Cord Injury: A Narrative Review
Rodriguez, G. M., & Gater, D. R. (2022) · Journal of Personalized Medicine · doi:10.3390/jpm12071141 · Cited by 49
“High-fiber foods maintain more fluid in the stools, improve bulk and elasticity, and decrease colonic pressures [20,21,66].”
BackgroundInfluentialQiu, B., Zhu, L. Q., Zhang, S., Han, S., Fei, Y., Ba, F., Berglund, B., Li, L., & Yao, M. (2022) · Nutrients · doi:10.3390/nu14194083 · Cited by 51
“Currently, the global prevalence of persons suffering from constipation, which seriously influences their life quality and mental status, is around 15% and increasing [2].”
BackgroundTanner, S. E., Chaudhry, A., Goraya, N., Badlani, R., Jehangir, A., Shahsavari, D., Malik, Z. A., & Parkman, H. P. (2021) · Journal of Clinical Medicine · doi:10.3390/jcm10092027 · Cited by 45
“Two techniques commonly used in the evaluation of patients with constipation are anorectal manometry (ARM) to assess pelvic floor function and colonic transit testing [3].”
MethodEvidence-Based Clinical Guidelines for Chronic Constipation 2023
Ihara, E., Manabe, N., Ohkubo, H., Ogasawara, N., Ogino, H., Kakimoto, K., Kanazawa, M., Kawahara, H., Kusano, C., Kuribayashi, S., et al. (2024) · Digestion · doi:10.1159/000540912 · Cited by 60
Nanocrystalline Cellulose Cures Constipation via Gut Microbiota Metabolism
Wang, M., Cha, R., Hao, W., Du, R., Zhang, P., Hu, Y., & Jiang, X. (2022) · ACS Nano · doi:10.1021/acsnano.2c05809 · Cited by 43
Aquaporin: targets for dietary nutrients to regulate intestinal health
Lv, H., Li, Y., Xue, C., Dong, N., Bi, C., & Shan, A. (2021) · Journal of Animal Physiology and Animal Nutrition · doi:10.1111/jpn.13539 · Cited by 42
“The pathogenesis of constipation involves multiple mechanisms, including daily diet (Lim et al., 2019), genetic susceptibility, intestinal motility and absorption rates, and biological and pharmaceutical factors (Bharucha & Lacy, 2020).”
BackgroundCao, J., Wang, K., Li, N., Zhang, L., Qin, L., He, Y., Wang, J., Qu, C., & Miao, J. (2022) · International Journal of Biological Macromolecules · doi:10.1016/j.ijbiomac.2022.11.243 · Cited by 42
Chang, L., Chey, W. D., Imdad, A., Almario, C. V., Bharucha, A. E., Diem, S. J., Greer, K. B., Hanson, B., Harris, L. A., Ko, C. W., et al. (2023) · The American Journal of Gastroenterology · doi:10.14309/ajg.0000000000002227 · Cited by 48
“This guideline does not review anorectal evacuation disorders that were evaluated in a recent ACG guideline (87) and an AGA review (80).”
BackgroundSelf-citationJiang, H., Ma, R.-A., Ji, F., Liu, Y., Wang, B., Fu, S., Ma, L., Wang, S., Liu, C., Guo, Z., et al. (2024) · International Journal of Biological Macromolecules · doi:10.1016/j.ijbiomac.2024.129527 · Cited by 41
New Understanding on the Pathophysiology and Treatment of Constipation in Parkinson’s Disease
Xu, J., Wang, L., Chen, X., & Le, W. (2022) · Frontiers in Aging Neuroscience · doi:10.3389/fnagi.2022.917499 · Cited by 41
2022 Seoul Consensus on Clinical Practice Guidelines for Functional Constipation
Cho, Y. S., Lee, Y. J., Shin, J. E., Jung, H., Park, S., Kang, S. J., Song, K. H., Kim, J., Lim, H. C., Park, H. S., et al. (2023) · Journal of Neurogastroenterology and Motility · doi:10.5056/jnm23066 · Cited by 47
“40,49 Recently, the US Multi-society Task Force on Colorectal Cancer suggested that average-risk colorectal cancer screening should begin at 45 years of age and is not recommended after 85 years of age.”
Qi, B., Zhang, Y., Ren, D., Qin, X., Wang, N., & Yang, X. (2023) · Journal of Agricultural and Food Chemistry · doi:10.1021/acs.jafc.2c07709 · Cited by 39
Total collagen content and distribution is increased in human colon during advancing age
Baidoo, N., Crawley, E., Knowles, C. H., Sanger, G. J., & Belai, A. (2022) · PLoS ONE · doi:10.1371/journal.pone.0269689 · Cited by 36
Engineered 5-HT producing gut probiotic improves gastrointestinal motility and behavior disorder
Li, B., Li, M., Luo, Y., Li, R., Li, W., & Liu, Z. (2022) · Frontiers in Cellular and Infection Microbiology · doi:10.3389/fcimb.2022.1013952 · Cited by 39
“Chronic constipation (CC) is a common functional gastrointestinal (GI) disorder with a 15% global prevalence (Bharucha and Lacy, 2020).”
BackgroundCharacteristics of the Gut Microbiome and Serum Metabolome in Patients with Functional Constipation
Wang, J., Wang, L., Yu, Q., Tang, N., Mei, C., Zhang, H., Wang, G., Lu, J., & Chen, W. (2023) · Nutrients · doi:10.3390/nu15071779 · Cited by 38
“The etiology and pathophysiology of FC are largely unknown [4] and involve complex interactions of multiple factors, such as the central and peripheral nervous system, gut motility, intestinal barrier, and the balance of the gut microecology.”
BackgroundTan, A. H., Chuah, K. H., Beh, Y. Y., Schee, J. P., Mahadeva, S., & Lim, S. (2023) · Journal of Movement Disorders · doi:10.14802/jmd.22220 · Cited by 41
Metabolomics Insights into Gut Microbiota and Functional Constipation
Zheng, F., Yang, Y., Lu, G., Tan, J. S., Mageswary, M. U., Zhan, Y., Ayad, M. E., Lee, Y. Y., & Xie, D. (2025) · Metabolites · doi:10.3390/metabo15040269 · Cited by 42
“Constipation has emerged as a significant global health concern, exerting detrimental impacts not only on physical wellbeing but also contributing to psychological distress and imposing substantial socioeconomic burdens [1].”
Yin, P., & Wang, H. (2022) · Computational and Mathematical Methods in Medicine · doi:10.1155/2022/1786994 · Cited by 33
“However, the current research on artificial intelligence algorithms in the medical field mostly focused on the segmentation of tumor or hemorrhagic disease lesions, and there was almost no application on pelvic floor injury diseases [23, 24].”
BackgroundEffect of old age on the subpopulations of enteric glial cells in human descending colon
Baidoo, N., Sanger, G. J., & Belai, A. (2022) · Glia · doi:10.1002/glia.24272 · Cited by 33
Gao, X., Hu, Y., Tao, Y., Liu, S., Chen, H., Li, J., Zhao, Y. M., Sheng, J., Tian, Y., & Fan, Y. (2022) · Frontiers in Microbiology · doi:10.3389/fmicb.2022.1017804 · Cited by 33
“In recent years, due to changes in the human diet and lifestyle, constipation has become increasingly common and has gradually reduced people’s quality of life (Bharucha and Lacy, 2020).”
BackgroundWang, J., Yang, M., Xu, K., Wan, X., Xie, J., Yu, H., Fang, J., Wang, Z., & Xu, P. (2023) · Frontiers in Physiology · doi:10.3389/fphys.2023.1204146 · Cited by 33
“The etiology of constipation is complex and associated with colonic sensorimotor disturbances, pelvic floor dysfunction, changes in colon physiology, and various colonic diseases (Bharucha and Lacy, 2020).”
BackgroundCheng, S., Li, B., Ding, Y., Hou, B., Hung, W., He, J., Jiang, Y., Zhang, Y., & Man, C. (2023) · Journal of Dairy Science · doi:10.3168/jds.2023-24154 · Cited by 33
“The etiology of constipation is currently understood to be heterogeneous and multifactorial, with dietary interventions being widely explored as a means to alleviate symptoms (Bharucha and Lacy, 2020; Li et al., 2022).”
BackgroundYang, S., Wu, X., Wang, S.-Q., Guo, X., Guo, F.-Z., & Sun, X. (2022) · Frontiers in Nutrition · doi:10.3389/fnut.2022.856138 · Cited by 33
Xu, M., Guo, Y., Chen, Y., Zhang, W., Wang, L., & Li, Y. (2023) · Journal of Chinese Integrative Medicine · doi:10.1016/j.joim.2023.05.003 · Cited by 35
Sharma, M., Muthyala, A., Feuerhak, K. J., Narayanan, S. P., Bailey, K. R., & Bharucha, A. E. (2020) · Neurogastroenterology & Motility · doi:10.1111/nmo.13910 · Cited by 32
Self-citationQu, J., Xu, X., Xu, C., Ding, X., Zhang, K., & Hu, L. (2023) · Frontiers in Nutrition · doi:10.3389/fnut.2023.1214774 · Cited by 30
“This may be attributed to colonic sensorimotor disturbance, which is a well-established cause of constipation (38).”
BackgroundAcupuncture influences multiple diseases by regulating gut microbiota
Xu, H., Luo, Y., Li, Q., & Zhu, H. (2024) · Frontiers in Cellular and Infection Microbiology · doi:10.3389/fcimb.2024.1371543 · Cited by 33
Zhang, H., Zu, Q., Zhang, J., Liu, S., Zhang, G., Chang, X., & Li, X. (2024) · Foods · doi:10.3390/foods13142220 · Cited by 31
Wang, L., Wang, J., Wang, J., Guo, Z., Li, Z., Qiu, J., & Wang, L. (2024) · Food Chemistry X · doi:10.1016/j.fochx.2024.101996 · Cited by 30
Forno, S. D., Cocchi, L., Arena, A., Pellizzone, V., Lenzi, J., Raffone, A., Borghese, G., Paradisi, R., Youssef, A., Casadio, P., et al. (2023) · Medicina · doi:10.3390/medicina60010067 · Cited by 29
“Moreover, biofeedback therapy is the mainstay for treating the condition, because it permits to “correct the dyssynergia or incoordination of abdominal and pelvic floor muscles during evacuation and improve perception of rectal filling in patients with impaired rectal sensation” [37,38].”
BackgroundMa, T., Li, Y., Yang, N., Wang, H., Shi, X., Liu, Y., Jin, H., Kwok, L., Sun, Z., & Zhang, H. (2025) · Cell Reports Medicine · doi:10.1016/j.xcrm.2025.102093 · Cited by 31
“1 While high-fiber diets are recommended, adequate fluid intake is essential to prevent side effects.”
Deb, B., Sharma, M., Fletcher, J. G., Srinivasan, S. G., Chronopoulou, A., Chen, J., Bailey, K. R., Feuerhak, K. J., & Bharucha, A. E. (2021) · Gastroenterology · doi:10.1053/j.gastro.2021.12.257 · Cited by 29
Self-citationSayuk, G. S., Waldman, S. A., & Brenner, D. M. (2022) · The American Journal of Gastroenterology · doi:10.14309/ajg.0000000000001687 · Cited by 29
“The diphenylmethane laxatives bisacodyl and sodium picosulfate yield an identical active metabolite, bis-(p-hydroxyphenyl)-pyridyl-2-methane, through conversion by mucosa deacetylase enzymes and desulfatases of the colonic microflora (31,32).”
BackgroundWang, Z., Shi, Y., Zeng, S., Zheng, Y., Wang, H., Liao, H., Song, J., Zhang, X., Cao, J., & Li, C. (2023) · International Journal of Molecular Sciences · doi:10.3390/ijms24032553 · Cited by 29
“As a typical intestinal disorder, constipation is characterized by dry stools, prolonged defecation time, and difficult defecation [1].”
BackgroundWei, Y., Huang, N., Ye, X., Liu, M., Wei, M., & Huang, Y. (2023) · Frontiers in Nutrition · doi:10.3389/fnut.2023.1103463 · Cited by 29
“It’s reported that the global incidence of constipation has reached 15% just in 2020 (1), and the prevalence of constipation in the elderly is as high as 27% (2), and the prevalence increased with the increase of age (3).”
BackgroundWu, S., Yuan, G., Wu, L., Zou, L., & Wu, F. (2024) · Journal of Affective Disorders · doi:10.1016/j.jad.2024.05.124 · Cited by 30
Alavi, K., Thorsen, A. J., Fang, S. H., Burgess, P. L., Trevisani, G., Lightner, A. L., Feingold, D. L., & Paquette, I. M. (2024) · Diseases of the Colon & Rectum · doi:10.1097/dcr.0000000000003430 · Cited by 29
Lin, Q., Liu, M., Erhunmwunsee, F., Li, B., Mou, Y., Wang, S., Zhang, G., & Tian, J. (2022) · Journal of Ethnopharmacology · doi:10.1016/j.jep.2022.115575 · Cited by 29
Chronic constipation: from pathophysiology to management
Barbara, G., Barbaro, M. R., Marasco, G., & Cremon, C. (2023) · Minerva Gastroenterology · doi:10.23736/s2724-5985.22.03335-6 · Cited by 30
Zhang, T., Liu, W., Lu, H., Cheng, T., Wang, L., Wang, G., Zhang, H., & Chen, W. (2023) · Critical Reviews in Food Science and Nutrition · doi:10.1080/10408398.2023.2278155 · Cited by 30
“Primary chronic constipation is diagnosed after excluding secondary causes of constipation and several overlapping subtypes (Rao, Rattanakovit, and Patcharatrakul 2016), including normal transit constipation, slow transit constipation (STC), and defecatory disorders (Bharucha and Lacy 2020).”
Feng, C., Gao, G., Wu, K., & Weng, X. (2024) · Frontiers in Microbiology · doi:10.3389/fmicb.2024.1438778 · Cited by 30
“…02 frontiersin.org 1 Introduction Constipation is an intestinal disorder based on symptoms such as difficult, infrequent or incomplete bowel movements, dry, hard stools, which affects around 15% of the global population (Mancabelli et al., 2017; Bharucha and Lacy, 2020; Hojo et al., 2023).”
BackgroundDevelopment and Assessment of a Pictographic Pediatric Constipation Action Plan
Reeves, P. T., Kolasinski, N. T., Yin, H. S., Alqurashi, W., Echelmeyer, S., Chumpitazi, B. P., Rogers, P. L., Burklow, C. S., & Nylund, C. M. (2020) · The Journal of Pediatrics · doi:10.1016/j.jpeds.2020.10.001 · Cited by 27
“Given the previous lack of validated CAP tools available to providers, and a subsequent lack of literature to support the use of CAP tools in children, our USCAP has the potential to improve individualized care within the patient-centered medical home model and inform the development of clinical practice guideline rec…”
BackgroundHow do probiotics alleviate constipation? A narrative review of mechanisms
Huang, Y.-P., Shi, J.-Y., Luo, X.-T., Luo, S.-C., Cheung, P. C. K., Corke, H., Yang, Q.-Q., & Zhang, B. (2024) · Critical Reviews in Biotechnology · doi:10.1080/07388551.2024.2336531 · Cited by 28
“Studies have reported that the number of Bifidobacterium and Lactobacillus in constipation sufferers decreased [41–43], and the number of some opportunistic pathogens increased [44,45].”
Sun, C., Zhu, J., Sun, X., Zhang, Z., Sun, Y., Jin, Y., & Wu, T. (2025) · Journal of Advanced Research · doi:10.1016/j.jare.2025.12.032 · Cited by 31
“Chronic constipation is a common GI disorder linked to intestinal inflammation that severely compromises patients ’ quality of life [169].”
Dong, L., Xu, Z., Huang, G., Zhang, R., Deng, M., Huang, F., & Su, D. (2023) · Journal of Agricultural and Food Chemistry · doi:10.1021/acs.jafc.3c03734 · Cited by 29
Influence of Flax Seeds on the Gut Microbiota of Elderly Patients with Constipation
Ma, J., Sun, J., Bai, H., Ma, H., Wang, K., Wang, J., Xiaofeng, Y., Pan, Y., & Yao, J. (2022) · Journal of Multidisciplinary Healthcare · doi:10.2147/jmdh.s379708 · Cited by 25
“The currently available treatments for constipation include non-pharmacological treatments, pharmacological treatments, transplantation of fecal bacteria, and surgery.(19) Owing to the challenges associated with long-term medication in middle-aged or elderly populations and the high incidence of complications and trau…”
BackgroundLobo, B., Tramullas, M., Finger, B. C., Lomasney, K. W., Beltrán, C. J., Clarke, G. A., Santos, J., Hyland, N. P., Dinan, T. G., & Cryan, J. F. (2023) · Journal of Neurogastroenterology and Motility · doi:10.5056/jnm22009 · Cited by 24
“31,32 In terms of animal models, different approaches have been used to provide a better understanding of the pathophysiology of constipation where changes in density and/or altered morphology of the ENS, as well as altered neurotransmission, have been found.”
Aberrant functional brain network dynamics in patients with functional constipation
Yin, T., He, Z., Ma, P., Sun, R., Xie, K., Liu, T., Chen, L., Chen, J., Hou, L., Teng, Y., et al. (2021) · Human Brain Mapping · doi:10.1002/hbm.25663 · Cited by 22
“…between CB crus II and aINS might explain the dual impairments in colonic sensory perception and autonomic rhythmic peristalsis in FCon patients, which was highly consistent with the most widely recognized pathogenic mechanism of FCon, the disturbance of colonic SM (Bharucha & Lacy, 2020).”
ResultDing, F., Hu, M., Ding, Y., Meng, Y., & Zhao, Y. (2024) · BMJ Open · doi:10.1136/bmjopen-2023-074557 · Cited by 22
Wei, M., Wang, N., Yin, Z., Wu, T., Zhou, S., Dang, L., Zhang, Z., Wu, D., Gao, P., Zhang, B., et al. (2020) · Journal of Gastrointestinal Surgery · doi:10.1007/s11605-020-04806-0 · Cited by 22
Bharucha, A., & Knowles, C. (2022) · Neurogastroenterology and Motility · doi:10.1111/nmo.14453 · Cited by 16
Self-citationThe Crucial Role of the Interstitial Cells of Cajal in Neurointestinal Diseases
Choi, E. L., Taheri, N., Tan, E., Matsumoto, K., & Hayashi, Y. (2023) · Biomolecules · doi:10.3390/biom13091358 · Cited by 23
“Slow-transit constipation (STC), a subtype of chronic constipation, is characterized by reduced colonic motility, resulting in the delayed passage of stools through the intestines [124].”
BackgroundConstipation in Patients With Chronic Kidney Disease
Cha, R. R., Park, S., & Camilleri, M. (2023) · Journal of Neurogastroenterology and Motility · doi:10.5056/jnm23133 · Cited by 28
Lee, J., Kim, G., Han, K., Jung, E.-J., Suh, H. J., & Jo, K. (2024) · Food & Function · doi:10.1039/d4fo00999a · Cited by 24
Chen, K., Wang, K.-L., Chen, C., Zhu, Y.-J., Tang, W.-W., Wang, Y., Chen, Z., He, L., Chen, Y.-G., & Zhang, W. (2024) · World Journal of Gastroenterology · doi:10.3748/wjg.v30.i20.2709 · Cited by 22
“Currently, constipation is initially managed through the administration of dietary fiber and suitable stimulants or osmotic laxatives, with subsequent consideration of gut secreta-gogues or prokinetic agents, if necessary[2].”
Gallas, S., Knaz, H., Methnani, J., Kanzali, M. M., Koukane, A., Bedoui, M. H., & Latiri, I. (2022) · Libyan Journal of Medicine · doi:10.1080/19932820.2022.2082029 · Cited by 21
Wang, Q., Shen, F., Zhang, J., Cai, H., Pan, Y., Sun, T., Gong, Y., Du, J., Zhong, H., & Feng, F. (2022) · Molecular Nutrition & Food Research · doi:10.1002/mnfr.202200313 · Cited by 20
Recognizing and Defining Occasional Constipation: Expert Consensus Recommendations
Rao, S. S. C., Lacy, B. E., Emmanuel, A. V., Müller-Lissner, S. A., Pohl, D., Quigley, E. M. M., & Whorwell, P. J. (2022) · The American Journal of Gastroenterology · doi:10.14309/ajg.0000000000001945 · Cited by 25
Self-citationGong, W., Li, R., Dai, Q., & Yu, P. (2022) · Journal of Gastroenterology and Hepatology · doi:10.1111/jgh.15994 · Cited by 21
Qin, L.-L., Yu, M., Yang, P., & Zou, Z. (2023) · Journal of Ethnopharmacology · doi:10.1016/j.jep.2023.117637 · Cited by 23
Yao, J., Chen, L., Xiao, X., Hou, T., Zhou, S., Xu, M., Wang, K., Hou, Y., Zhang, L., & Li, Y. (2021) · Journal of Chinese Integrative Medicine · doi:10.1016/j.joim.2021.11.001 · Cited by 21
Xia, T., Huang, F., Yun, F., Liu, Y., Wang, T., Wang, S., Jin, S., Ma, X., Wang, W., He, J., et al. (2024) · Current Research in Food Science · doi:10.1016/j.crfs.2024.100924 · Cited by 22
Kamiya, T., Osaga, S., Kubota, E., Fukudo, S., Motoya, S., Murakami, K., Nagahara, A., Shiotani, A., Sugimoto, M., Suzuki, H., et al. (2020) · Digestion · doi:10.1159/000513292 · Cited by 20
Yu, T., Ding, Y., Qian, D., Lin, L., & Tang, Y. (2023) · Therapeutic Advances in Gastroenterology · doi:10.1177/17562848231154101 · Cited by 20
Punukollu, R. S., Chadalawada, A. K., Siddabattuni, K., & Gogineni, N. T. (2023) · Journal of Ethnopharmacology · doi:10.1016/j.jep.2023.116997 · Cited by 21
Metadata
- Authors
- Bharucha, A. E., & Lacy, B. E.
- Affiliations
- Mayo Clinic (US)
- Corresponding author
- Bharucha, Adil E.
- Venue
- Gastroenterology
- Publisher
- Elsevier BV
- Published
- 2020-04
- Volume
- 158
- Issue
- 5
- Pages
- 1232-1249.e3
- ISSN
- 0016-5085 (ISSN-L)
- PMC
- PMC7573977
- OpenAlex
- W3000300599
- Cited by
- 655
- References
- 170
- Citations by year
- 2026: 108 · 2025: 157 · 2024: 115 · 2023: 99 · 2022: 112 · 2021: 46 · 2020: 17
- FWCI
- 11.88
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Gastroenterology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Diabetes and Digestive and Kidney Diseases
- Topics
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
- Health Sciences › Medicine › Urology › Pelvic floor disorders treatments
- Health Sciences › Medicine › Surgery › Congenital gastrointestinal and neural anomalies
- Keywords
- chronic constipation, defecation disorders, slow transit constipation, colonic transit, colonic motility, pelvic floor dysfunction, dietary fiber supplementation, laxatives, prokinetic agents, opioid-induced constipation, biofeedback, anorectal manometry, barostat, colectomy, constipation treatment
- MeSH terms
- Secretagogues, Chronic Disease, Colon, Constipation, Defecation, Dietary Fiber, Electromyography, Gastrointestinal Motility, Humans, Intestinal Mucosa, Magnetic Resonance Imaging, Manometry, Rectum, Prevalence, Receptors, Opioid, mu, Pelvic Floor, Dietary Supplements, Defecography, Digital Rectal Examination, Laxatives
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
