Cited by 655Gastrointestinal motility and disordersPelvic floor disorders treatmentsCongenital gastrointestinal and neural anomalies

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 access

Bharucha, Adil E., Lacy, Brian E.·2020·Gastroenterology

DOI 10.1053/j.gastro.2019.12.034PMC PMC7573977

Open this paper in CoChat — free account

Abstract

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.

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

Crossref · 10.1053/j.gastro.2019.12.034

Cites

170 of 170 references verified0 citation errors · 0 not checkable

Statistics

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?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Bowel Disorders
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-citation
Burden and Cost of Gastrointestinal, Liver, and Pancreatic Diseases in the United States: Update 2018
Peery, 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-citation
Functional 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-citation
Defecography 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
Efficacy of prebiotics, probiotics, and synbiotics in irritable bowel syndrome and chronic idiopathic constipation: systematic review and meta-analysis
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-citation
Myths 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

Show all 170 references

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

Sorted by citations

Items 101–200 of 654

Reconstruction and Dynamics of the Human Intestinal Microbiome Observed In Situ
Liu, X., Dai, M., Ma, Y., Zhao, N., Wang, Z., Yu, Y., Xu, Y., Zhang, H., Xiang, L., Tian, H., et al. (2021) · Engineering · doi:10.1016/j.eng.2021.03.015 · Cited by 20
Alleviation of loperamide‐induced constipation with sticky rice fermented huangjiu by the regulation of serum neurotransmitters and gut microbiota
Feng, X., Shi, Y., Zhou, Z., Ji, Z., Zhou, W., Chen, S., & Ma, D. (2022) · Journal of the Science of Food and Agriculture · doi:10.1002/jsfa.12181 · Cited by 20
Rectal hyposensitivity: a common pathophysiological finding in patients with constipation and associated hypermobile Ehlers–Danlos syndrome
Choudhary, A., Vollebregt, P. F., Aziz, Q., Scott, S. M., & Fikree, A. (2022) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.17104 · Cited by 18
Butyrogenic, bifidogenic and slight anti-inflammatory effects of a green kiwifruit powder (Kiwi FFG®) in a human gastrointestinal model simulating mild constipation
Goya‐Jorge, E., Bondue, P., Gonza, I., Laforêt, F., Antoine, C., Boutaleb, S., Douny, C., Scippo, M., de Ribaucourt, J. C., Crahay, F., et al. (2023) · Food Research International · doi:10.1016/j.foodres.2023.113348 · Cited by 20
Association between Dietary Intake of Live Microbes and Chronic Constipation in Adults
Yang, C., Hong, Q., Wu, T., Fan, Y., Shen, X., & Dong, X. (2023) · Journal of Nutrition · doi:10.1016/j.tjnut.2023.11.032 · Cited by 19
Synergistic effects of Ligilactobacillus salivarius Li01 and psyllium husk prevent mice from developing loperamide-induced constipation
Xu, L., Qiu, B., Ba, F., Zhang, S., Han, S., Chen, H., Wu, Y., Gao, W., Xie, S., Chen, Y., et al. (2024) · Food & Function · doi:10.1039/d4fo04444d · Cited by 20
Laxative effect of mulberry ferment on two models of constipated mice
He, Y., Liu, G., Chen, X., Chen, J., Zhao, J., Li, X., Deng, J., Wang, X., Xiang, Z., & Zeng, P. (2022) · Journal of Functional Foods · doi:10.1016/j.jff.2022.104971 · Cited by 18
Exploring the connection between caffeine intake and constipation: a cross-sectional study using national health and nutrition examination survey data
Kang, Y., & Jin, Y. (2024) · BMC Public Health · doi:10.1186/s12889-023-17502-w · Cited by 18
“Generally, dietary adjustment is considered for constipation prior to medical intervention for the purpose of minimizing side effects of some drugs [7]; therefore, some dietary factors have been found to be associated with constipation [8, 9].”
Background
Association of Ultra-processed Food and Unprocessed or Minimally Processed Food Consumption With Bowel Habits Among U.S. Adults
Lo, C., Zhao, L., Steele, E. M., Pan, C., Lee, J. K., Zhang, X., Singh, H., & Samadder, N. J. (2024) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2024.04.036 · Cited by 19
Optimizing techniques for measuring anal resting and squeeze pressures with high‐resolution manometry
Oblizajek, N. R., Deb, B., Ramu, S. K., Chunawala, Z. S., Feuerhak, K. J., Bailey, K. R., & Bharucha, A. E. (2022) · Neurogastroenterology & Motility · doi:10.1111/nmo.14383 · Cited by 17
Self-citation
Ameliorating and Sustained Effects and Autonomic Mechanisms of Transcutaneous Electrical Acustimulation at ST36 in Patients with Chronic Constipation
Zhou, J.-Y., Wang, J., Ning, B., Hu, Y., Zhao, Q., Tan, W., Shi, P., Yuan, Z.-L., Feng, X., Chen, J. D. Z., et al. (2022) · Frontiers in Neuroscience · doi:10.3389/fnins.2022.1038922 · Cited by 17
“Chronic constipation is one of the most common gastrointestinal (GI) disorders, affecting approximately 15% of the global population (Bharucha and Lacy, 2020) and 37.”
Background
A Randomized, Double-Blind, Controlled Trial of Percutaneous Tibial Nerve Stimulation With Pelvic Floor Exercises in the Treatment of Childhood Constipation
Yu, Z.-T., Song, J., Qiao, L., Wang, Y., Chen, Y., Wang, E.-H., & Zhang, S. (2023) · The American Journal of Gastroenterology · doi:10.14309/ajg.0000000000002188 · Cited by 17
“Because the factors that influence HR-ARM and sEMG are different, the combined use of these 2 methods overcomes the respective technical defects and improves the accuracy of function assessment (5,14).”
Method
Position paper on transanal irrigation in chronic non-organic constipation
Bazzocchi, G., Corazziari, E. S., Staiano, A., Bassotti, G., Bellini, M., Chiarioni, G., D’Alba, L., & Scarpato, E. (2024) · Digestive and Liver Disease · doi:10.1016/j.dld.2024.02.006 · Cited by 17
Incidence of ‘new-onset’ constipation and associated factors during lockdown due to the COVID-19 pandemic
Remes-Troche, J. M., Coss‐Adame, E., Amieva‐Balmori, M., Velasco, J. A. V.-R., Gómez-Castaños, P. C., Flores-Rendón, R., Gomez-Escudero, O., Rodríguez-Leal, M. C., Durán-Rosas, C., Gálvez, S. M. P., et al. (2021) · BMJ Open Gastroenterology · doi:10.1136/bmjgast-2021-000729 · Cited by 20
A comparison of rectoanal pressures during Valsalva maneuver and evacuation uncovers rectoanal discoordination in defecatory disorders
Srinivasan, S. G., Sharma, M., Feuerhak, K. J., Bailey, K. R., & Bharucha, A. E. (2021) · Neurogastroenterology & Motility · doi:10.1111/nmo.14126 · Cited by 16
Self-citation
Evaluation of the effect of prebiotic sesame candies on loperamide-induced constipation in mice
Xia, P., Liu, X., Hou, T., Zhan, F., Geng, F., Zhang, Z., & Li, B. (2022) · Food & Function · doi:10.1039/d2fo00067a · Cited by 16
Laparoscopic total colectomy with ileorectal anastomosis and subtotal colectomy with antiperistaltic cecorectal anastomosis for slow transit constipation
Deng, X.-M., Zhu, T.-Y., Wang, G.-J., Gao, B.-L., Li, R., & Wang, J. (2023) · Updates in Surgery · doi:10.1007/s13304-023-01458-y · Cited by 16
Difficult defecation in constipated patients: Diagnosis by minimally invasive diagnostic tests
Chiarioni, G., Lambiase, C., Whitehead, W. E., Rettura, F., Morganti, R., Popa, S., & Bellini, M. (2023) · Digestive and Liver Disease · doi:10.1016/j.dld.2023.06.004 · Cited by 16
Effects of Lactiplantibacillus plantarum GUANKE on Diphenoxylate-Induced Slow Transit Constipation and Gut Microbiota in Mice
Huang, Y., Guo, Y., Li, X., Xiao, Y., Wang, Z., Song, L., & Ren, Z. (2023) · Nutrients · doi:10.3390/nu15173741 · Cited by 20
“Common treatment includes laxatives, sacral nerve stimulation, and biofeedback, aiming to restore normal intestinal motility and relieve the symptoms of constipation, but they are questioned for long-term use [13].”
Background
Identification of symptom clusters and sentinel symptoms during the first cycle of chemotherapy in patients with lung cancer
Luo, Y., Mao, D., Zhang, L., Yang, Z., Miao, J., & Zhang, L. (2024) · Supportive Care in Cancer · doi:10.1007/s00520-024-08600-5 · Cited by 16
“Additionally, the use of pain medications has been identified as a potential contributor to constipation [51].”
Background
Fragments of a pectin from Arctium lappa L: Molecular properties and intestinal regulation activity
Yu, J., Ye, M., Li, K., Wang, F., Shi, X., Pan, C. S., Yang, X., Gao, X., & Liu, W. (2021) · Journal of Functional Foods · doi:10.1016/j.jff.2021.104900 · Cited by 16
Plasma metabolomic proﬁles reveal regulatory effect of chitosan oligosaccharides on loperamide-induced constipation in mice
Zhang, X., Hu, B., Sun, G., Zheng, J., Hu, H., Yang, H., Cheng, X., Lin, A., & Liu, H. (2022) · Journal of Pharmaceutical and Biomedical Analysis · doi:10.1016/j.jpba.2022.114590 · Cited by 16
Management of Sexual Dysfunction in Gastrointestinal Disorders
Bedell, A., & Friedlander, A. (2022) · Gastroenterology Clinics of North America · doi:10.1016/j.gtc.2022.06.012 · Cited by 15
In Vitro Fermentation of Different Indigestible Glucans with Varying Physico-Chemical Properties by Human Fecal Microbiota
Zhang, H., Chen, C., Zhang, Y. L., Yin, H., Hu, J., Zhong, Y., Nie, S., & Xie, M. (2023) · Fermentation · doi:10.3390/fermentation9050485 · Cited by 15
Arecoline alleviated loperamide induced constipation by regulating gut microbes and the expression of colonic genome
Xu, M. Y., Wang, W., Su, S., Li, W., Hu, X., & Zhang, J. (2023) · Ecotoxicology and Environmental Safety · doi:10.1016/j.ecoenv.2023.115423 · Cited by 16
Association of environmental tobacco smoke exposure with chronic constipation: a nationwide survey (NHANES 2005–2010)
Duan, R., Zheng, Y., Kong, W., Wang, Y., & Zhou, Y. (2023) · Environmental Science and Pollution Research · doi:10.1007/s11356-023-30542-4 · Cited by 15
“Chronic constipation is one of the most common gastrointestinal symptoms (Bharucha and Lacy 2020), affecting about 6.6 to 10.1% of adults worldwide (Barberio et al. 2021; Sperber et al. 2021) and imposing a heavy burden on the healthcare resources.”
BackgroundMethodInfluential
Receptors for pro-resolving mediators as a therapeutic tool for smooth muscle remodeling-associated disorders
Livshits, G., & Kalinkovich, A. (2020) · Pharmacological Research · doi:10.1016/j.phrs.2020.105340 · Cited by 16
AGA Clinical Practice Update on Evaluation and Management of Refractory Constipation: Expert Review
Staller, K. D., Neshatian, L., Lembo, A. J., & Bharucha, A. E. (2026) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2025.09.031 · Cited by 14
Self-citation
M1 macrophages-derived exosomes miR-34c-5p regulates interstitial cells of Cajal through targeting SCF
Xu, S., Zhai, J., Xu, K., Zuo, X., Wu, C., Lin, T., & Zeng, L. (2021) · Journal of Biosciences · doi:10.1007/s12038-021-00212-z · Cited by 14
Effects of Xiao Chengqi Formula on Slow Transit Constipation by Assessing Gut Microbiota and Metabolomics Analysis in vitro and in vivo
Zhou, Q., Zhang, D., Zhang, H., Wan, X., Hu, B., Zou, Q., Su, D., Peng, H., Huang, D., & Ren, D. (2022) · Frontiers in Pharmacology · doi:10.3389/fphar.2022.864598 · Cited by 14
Prevalence and Burden of Illness of Rome IV Chronic Idiopathic Constipation, Opioid-Induced Constipation, and Opioid-Exacerbated Constipation in the United States
Liang, J., Almario, C. V., Chey, W. D., Higgins, C. S., & Spiegel, B. M. R. (2023) · The American Journal of Gastroenterology · doi:10.14309/ajg.0000000000002376 · Cited by 15
“CIC is characterized by infrequent bowel movements, straining with defecation, hard stools, sensation of incomplete evacuation, sensation of anorectal obstruction, and the need for manual maneuvers to facilitate defecation (1,4).”
Background
The association between constipation and stroke based on the NHANES and Mendelian randomization study
Du, W., Yang, S., Zhou, H., Wu, Y., Cai, Y., Meng, H., Teng, H., & He, A. F. (2023) · Frontiers in Neuroscience · doi:10.3389/fnins.2023.1276032 · Cited by 17
Biopsychosocial Model and Perceived Constipation Severity According to the Constipation Phenotype
Bouchoucha, M. L., Fysekidis, M., Deutsch, D., Bejou, B., Sabaté, J., & Benamouzig, R. (2020) · Digestive Diseases and Sciences · doi:10.1007/s10620-020-06654-z · Cited by 14
Diagnostic Strategy and Tools for Identifying Defecatory Disorders
Bharucha, A. E., & Coss‐Adame, E. (2022) · Gastroenterology Clinics of North America · doi:10.1016/j.gtc.2021.10.002 · Cited by 14
Self-citation
Background factors involved in the epidemiology of functional constipation in the Japanese population: a cross-sectional study
Yamamoto, S., Ohashi, W., Yamaguchi, Y., Inamoto, S., Koshino, A., Sugiyama, T., Nagao, K., Tamura, Y., Izawa, S., Ebi, M., et al. (2022) · BioPsychoSocial Medicine · doi:10.1186/s13030-022-00237-2 · Cited by 14
Pelvic floor physical therapy in patients with chronic anal fissure: a randomized controlled trial
van Reijn-Baggen, D. A., Elzevier, H. W., Putter, H., Pelger, R. C. M., & Han‐Geurts, I. J. M. (2022) · Techniques in Coloproctology · doi:10.1007/s10151-022-02618-9 · Cited by 14
Comparative effects of different enzymatic hydrolysates of konjac glucomannan on gut flora and constipation in rats
Chang, X., Liu, Y., Hu, M., Liu, Y., Jiang, C., Wang, Q., Jin, Q., Zhang, D., Yin, Z., & Zhang, J. (2022) · Food & Function · doi:10.1039/d2fo01144a · Cited by 15
Advanced intestinal regulation improves bowel preparation quality in patients with constipation: A systematic review and network meta-analysis
Ding, L., Duan, J., Yang, T., Jin, C., Luo, J., & Ma, A. (2023) · Frontiers in Pharmacology · doi:10.3389/fphar.2022.964915 · Cited by 14
“With a global prevalence of 15%, constipation is a manifestation gastrointestinal dysmotility in clinic, and its prevalence would steadily rise after the age of 50 years, which is the recommended age to perform colonoscopy for colorectal lesion screening (Bharucha and Lacy, 2020).”
Background
Fecal Incontinence in Adults: New Therapies
Blackett, J. W., & Bharucha, A. E. (2025) · The American Journal of Gastroenterology · doi:10.14309/ajg.0000000000003413 · Cited by 13
Self-citation
Lactobacillus rhamnosus LRa05 Alleviates Constipation via Triaxial Modulation of Gut Motility, Microbiota Dynamics, and SCFA Metabolism
Zhang, J., Li, Q., Liu, S., Wang, N., Song, Y., Wu, T., & Zhang, M. (2025) · Foods · doi:10.3390/foods14132293 · Cited by 13
“Constipation, a prevalent global digestive disorder, is characterized by difficult defe-cation, dry stools, and infrequent bowel movements, significantly diminishing patients’ quality of life [1].”
Dietary Fiber as Prebiotics: A Mitigation Strategy for Metabolic Diseases
Gao, X., Hu, S., Liu, Y., Alwis, S. A. S. S. D., Yu, Y., Li, Z., Wang, Z., & Liu, J. (2025) · Foods · doi:10.3390/foods14152670 · Cited by 15
“Primary constipation is caused by intestinal dysfunction that makes it hard to pass feces out of the body without structural abnormalities or metabolic disorders [65].”
An Evidence-Based Practical Review on Common Benign Anorectal Disorders: Hemorrhoids, Anal Fissure, Dyssynergic Defecation, and Fecal Incontinence
Bharucha, A. E., Knowles, C. H., & Malcolm, A. (2025) · Gastroenterology · doi:10.1053/j.gastro.2025.07.031 · Cited by 13
Self-citation
Prevalence and impact of disorders of Gut–Brain interaction in Sweden
Tornkvist, N. T., Simrén, M., Hreinsson, J. P., Tack, J. F., Bangdiwala, S. I., Sperber, A. D., Palsson, O. S., Josefsson, A., & Törnblom, H. (2023) · Neurogastroenterology & Motility · doi:10.1111/nmo.14578 · Cited by 15
Adult Hirschsprung’s disease presenting as chronic constipation: a case report
Rahardjo, T. M., Nurzaman, Y. A., Natalia, J., Hapdijaya, I., Devina, L., Andrianto, H., & Mahardhika, J. C. (2023) · Journal of Medical Case Reports · doi:10.1186/s13256-023-03986-y · Cited by 13
“It can be either primary or secondary [6].”
Background
Shouhui Tongbian Capsule in treatment of constipation: Treatment and mechanism development
Gong, L., Du, H., Guo, X., Li, J., Zhu, X., Shen, X., Huang, Z., Wu, K., Zhang, G., & Sun, R. (2023) · Chinese Herbal Medicines · doi:10.1016/j.chmed.2023.05.006 · Cited by 13
“…system disease in the clinic and seriously affects the quality of life of patients, which is mainly manifested by a decrease in the frequency of bowel movements, dry and hard stools, and difﬁculty in defecation (Bharucha & Lacy, 2020; Camilleri et al., 2017; Zhang, Shen, Zhang, & Ye, 2017).”
Background
Real‐world outcomes for a digital prescription mobile application for adults with irritable bowel syndrome
Pathipati, M. P., Scott, L. L., Griser, A. C., & Staller, K. D. (2024) · Neurogastroenterology & Motility · doi:10.1111/nmo.14811 · Cited by 17
Abdomino-anal Dyscoordination in Defecatory Disorders
Srinivasan, S. G., Muthyala, A., Sharma, M., Feuerhak, K. J., Boon, A. J., Bailey, K. R., & Bharucha, A. E. (2021) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2021.11.040 · Cited by 13
Self-citation
Disorders of anorectal motility: Functional defecation disorders and fecal incontinence
Desprez, C., Bridoux, V., & Leroi, A. (2022) · Journal of Visceral Surgery · doi:10.1016/j.jviscsurg.2021.12.004 · Cited by 12
Colorectal motility patterns and psychiatric traits in functional constipation and constipation-predominant irritable bowel syndrome: A study from China
Lv, C., Song, G., Liu, J., Wang, W., Huang, Y., Wang, B., Tian, J.-S., Yin, M.-Q., & Yu, Y. (2023) · World Journal of Gastroenterology · doi:10.3748/wjg.v29.i41.5657 · Cited by 12
“Two principal contributors to the pathophysiology of CC are colonic sensorimotor disturbances and pelvic floor dysfunction[3,4].”
Tongbian decoction restores intestinal microbiota and activates 5-hydroxytryptamine signaling: implication in slow transit constipation
Li, H., Lv, N., Li, D., Qian, Y., Si, X., Hua, Y., Wang, Y., Han, X., & Xu, T. (2024) · Frontiers in Microbiology · doi:10.3389/fmicb.2023.1296163 · Cited by 12
Associations between gut microbiota characteristics and non‐motor symptoms following pharmacological and surgical treatments in Parkinson's disease patients
Górecka-Mazur, A., Krygowska‐Wajs, A., Furgała, A., Li, J., Misselwitz, B., Pietraszko, W., Kwinta, B. M., & Yılmaz, B. (2024) · Neurogastroenterology & Motility · doi:10.1111/nmo.14846 · Cited by 16
Green kiwifruit (lat. Actinidia deliciosa var. Hayward) and maintenance of normal defecation: evaluation of a health claim pursuant to Article 13(5) of Regulation (EC) No 1924/2006
EFSA Panel on Nutrition, N. F. A. F. A. (., Turck, D., Castenmiller, J. J. M., Henauw, S. D., Hirsch‐Ernst, K. I., Kearney, J., Knutsen, H. K., Maciuk, A., Mangelsdorf, I., McArdle, H. J., et al. (2021) · EFSA Journal · doi:10.2903/j.efsa.2021.6641 · Cited by 12
“It is established that an increased faecal mass promotes normal laxation (G elinas, 2013; Korczak et al., 2017; Bharucha and Lacy, 2020) that is mediated by an increasing diameter of the lumen of the colon, thereby decreasing intraluminal pressure and allowing increased forward flow of the faeces (Gregory and Strong,…”
Background
Comparative effectiveness of biofeedback and injectable bulking agents for treatment of fecal incontinence: Design and methods
Bharucha, A. E., Gantz, M. G., Rao, S. S. C., Lowry, A. C., Chua, H. K., Karunaratne, T. B., Wu, J. M., Hamilton, F. A., & Whitehead, W. E. (2021) · Contemporary Clinical Trials · doi:10.1016/j.cct.2021.106464 · Cited by 13
Self-citation
A prospective pilot study of the effects of deep brain stimulation on olfaction and constipation in Parkinson’s disease
Kola, S., Prichard, D. O., Bharucha, A. E., & Hassan, A. (2021) · Clinical Neurology and Neurosurgery · doi:10.1016/j.clineuro.2021.106774 · Cited by 12
Self-citation
Reproducibility of high‐resolution manometry among healthy and constipated persons
Mishra, R., Gautam, M., Oblizajek, N. R., & Bharucha, A. E. (2022) · Neurogastroenterology & Motility · doi:10.1111/nmo.14438 · Cited by 12
Self-citation
A pilot randomized placebo-controlled study on modified MaZiRenWan: a formulated Chinese medicine to relieve constipation for palliative cancer patients
Cheng, C. W., Mok, H.-F., Yau, C. W. S., Chan, J. T. M., Kang, Y.-C., Lam, P.-Y., Zhong, L. L. D., Zhao, C., Ng, B. F. L., Kwok, A. O. L., et al. (2022) · Chinese Medicine · doi:10.1186/s13020-022-00580-0 · Cited by 11
Astragaloside IV improves slow transit constipation by regulating gut microbiota and enterochromaffin cells
Wan, X., Zhou, Q., Chen, H., Li, Z., Mo, M., Liu, Z., Zhang, H., He, Z., Xiao, G., Zheng, Y., et al. (2023) · Frontiers in Pharmacology · doi:10.3389/fphar.2023.1196210 · Cited by 11
“Due to its intricate symptoms and high recurrence rate, STC treatment is dif ﬁ cult and conventional therapies often yield unsatisfactory results (Bharucha and Lacy, 2020).”
Background
The preparation of synbiotic AHY relieving loperamide-induced constipation and its modulation mechanism in vivo
Jiang, L., Zhang, R., Lin, X., Tuo, Y., Mu, G., & Jiang, S. (2024) · Food Bioscience · doi:10.1016/j.fbio.2024.104096 · Cited by 12
Shatianyu ( Citrus grandis L. Osbeck) whole fruit alleviated loperamide-induced constipation via enhancing gut microbiota-mediated intestinal serotonin secretion and mucosal barrier homeostasis
Deng, M., Ye, J., Zhang, R., Zhang, S., Dong, L., Su, D., Zhang, M., & Huang, F. (2024) · Food & Function · doi:10.1039/d4fo02765e · Cited by 11
The prevalence of constipation in end-stage kidney disease patients: A cross-sectional observation study
Zhang, L., Tang, F., Wang, F., Xie, Q., Xia, M., Jiang, L., Wang, Z., & Wang, B. (2022) · Medicine · doi:10.1097/md.0000000000031552 · Cited by 11
To what extent are anorectal function tests comparable? A study comparing digital rectal examination, anal electromyography, 3-dimensional high-resolution anal manometry, and transperineal ultrasound
Dekker, L., van Reijn-Baggen, D. A., Han‐Geurts, I. J. M., & Felt-Bersma, R. J. F. (2023) · International Journal of Colorectal Disease · doi:10.1007/s00384-022-04304-6 · Cited by 11
“The s-EMG with intra-vaginal or intra-anal electrode probes is commonly utilized by the pelvic floor physical therapist to confirm DRE and evaluate therapy [5, 10].”
Method
Arctiin alleviates functional constipation by enhancing intestinal motility in mice
Wang, Y., Jiang, H., Wang, L., Gan, H., Xiao, X., Huang, L., Li, W., & Li, Z. (2023) · Experimental and Therapeutic Medicine · doi:10.3892/etm.2023.11898 · Cited by 11
Physiology‐Based Stretchable Electronics Design Method for Accurate Surface Electromyography Evaluation
Wang, S., Dong, S., Li, W., Cen, J., Zhu, H., Fu, C., Jin, H., Li, Y., Feng, X., Luo, J., et al. (2021) · Advanced Science · doi:10.1002/advs.202004987 · Cited by 10
Quality of life and sexual health after perineal reconstruction in Fournier gangrene using pedicled anterolateral thigh flaps
Rossi, S. A., de Schoulepnikoff, C., Guillier, D., Raffoul, W., & Summa, P. G. D. (2022) · Frontiers in Surgery · doi:10.3389/fsurg.2022.994936 · Cited by 10
“Very few long term symptoms were reported: occasional constipation was one of them but did not seem to relate to the surgical procedure (debridement/ reconstruction); notwithstanding constipation being a frequent symptom in the general population, with an incidence of up to 15% worldwide (23).”
Background
Elobixibat improves rectal sensation in patients with chronic constipation aged ≥60 years: a randomised placebo-controlled study
Manabe, N., Umeyama, M., Ishizaki, S., Ota, T., Kuratani, S., Katsumata, R., Fujita, M., Haruma, K., & Camilleri, M. (2023) · BMJ Open Gastroenterology · doi:10.1136/bmjgast-2023-001257 · Cited by 11
“4 Although the pathophysiology of CC varies, slow colonic transit and high rectal sensory thresholds (RSTs) are important in older patients 5 ; and the RSTs of older patients are higher than those of younger ones.”
Integrated metabolomics and transcriptomics revealed the anti-constipation mechanisms of xylooligosaccharides from corn cobs
Song, H., Guo, R. H., Sun, X., Kou, Y., Ma, X., Chen, Y., Song, L., & Wu, Y. (2023) · Food & Function · doi:10.1039/d3fo04366e · Cited by 10
Altered gut microbial profile is associated with differentially expressed fecal microRNAs in patients with functional constipation
Yao, J., Yan, X., Li, Y., Chen, Y., Xiao, X., Zhou, S., Zhang, W., Wang, L., Chen, M., Zeng, F., et al. (2024) · Frontiers in Microbiology · doi:10.3389/fmicb.2023.1323877 · Cited by 11
“However, long-term reliance on laxatives can lead to adverse reactions such as laxative dependence, melanosis coli, and electrolyte imbalances (Bharucha and Lacy, 2020; Shah et al., 2021; Sharma et al., 2021).”
Background
Total Flavonoids of Aurantii Fructus Immaturus Regulate miR-5100 to Improve Constipation by Targeting Fzd2 to Alleviate Calcium Balance and Autophagy in Interstitial Cells of Cajal
Wen, Y., Zhan, Y., Chen, T., Li, J., Long, Q., Zheng, F., Tang, S., & Tang, X. (2024) · Molecular Neurobiology · doi:10.1007/s12035-024-03958-3 · Cited by 10
“According to modern studies, constipation can be divided into slow-transit constipation (STC), outlet obstructive constipation (OOC), and normal transit constipation (NTC) [4, 5].”
Defecatory disorders are a common cause of chronic constipation in Parkinson disease
Ramu, S. K., Oblizajek, N. R., Savica, R., Chunawala, Z. S., Deb, B., & Bharucha, A. E. (2024) · Neurogastroenterology & Motility · doi:10.1111/nmo.14767 · Cited by 10
“7,39,40 Although rational, that approach introduces refer - ral bias, which may tend to exaggerate the prevalence of anorectal or decision to submit for publication.”
BackgroundSelf-citation
Prevalence and patterns of laxative use in subjects with self-reported constipation: results from a multinational digestive health survey
Lacy, B. E., Delfini, R., Fladung, B., & Lange, R. (2024) · Therapeutic Advances in Gastroenterology · doi:10.1177/17562848241232605 · Cited by 11
Self-citation
Effect of Physical Activity on the Association Between Diet and Constipation: Evidence From the National Health and Nutrition Examination Survey 2007-2010
Lai, S., Zhu, C., Zhou, X., Zeng, Q., Huang, L., Cao, X., Zhou, Q., Zhong, Y., Huang, J., Liu, J., et al. (2024) · Journal of Neurogastroenterology and Motility · doi:10.5056/jnm23134 · Cited by 12
“39,40 Several components of the HEI-2015 have demonstrated associations with constipation.”
Background
Association of body roundness index with chronic diarrhea and constipation, NHANES 2005–2010
Zhuang, Y., Li, L., Sun, J., Zhang, Y., & Dai, F. (2025) · Journal of Health Population and Nutrition · doi:10.1186/s41043-025-00793-7 · Cited by 10
“Patients with chronic constipation present with a bowel movement frequency of less than 3 times/week, often accompanied by hard or lumpy stools, incomplete evacuation, and bloating [2].”
Rhizome of Atractylodes macrocephala alleviates spleen-deficiency constipation in rats by modulating gut microbiota and bile acid metabolism
Yang, P., Qin, L.-L., Yu, M., & Zou, Z. (2025) · Journal of Ethnopharmacology · doi:10.1016/j.jep.2025.119884 · Cited by 12
Characterization of mitochondria-associated ER membranes in the enteric nervous system under physiological and pathological conditions
Delfino, G., Briand, J. B., Oullier, T., Nienkemper, L., Greig, J., Véziers, J., Neunlist, M., Derkinderen, P., & Paillusson, S. (2024) · American Journal of Physiology-Gastrointestinal and Liver Physiology · doi:10.1152/ajpgi.00224.2023 · Cited by 10
Myths and Misconceptions About Constipation: A New View for the 2020s
Staller, K., & Cash, B. D. (2020) · American Journal of Gastroenterology · doi:10.14309/ajg.0000000000000947 · Cited by 10
Efficacy and safety of electroacupuncture for secondary constipation: a systematic review and meta-analysis
Liu, J., Shiping, L., Yue, X., & Fuli, Z. (2023) · International Journal of Colorectal Disease · doi:10.1007/s00384-023-04487-6 · Cited by 9
“Secondary constipation is classified as secondary to certain medications such as opioids or diseases such as stroke and Parkinson’s disease [9].”
Background
Effects of Liqi Tongbian decoction on gut microbiota, SCFAs production, and 5-HT pathway in STC rats with Qi Stagnation Pattern
Liu, Q., Ke, D., Chen, Y., Shen, A., Liu, L., Hu, L., Ren, Y., Fang, W., Zhao, P., Sferraf, T. J., et al. (2024) · Frontiers in Microbiology · doi:10.3389/fmicb.2024.1337078 · Cited by 12
The Clinical Utility of Anorectal Manometry: A Review of Current Practices
Belilos, E. A., Post, Z., Anderson, S., & DeMeo, M. T. (2024) · Gastro Hep Advances · doi:10.1016/j.gastha.2024.10.002 · Cited by 9
Gut Microbiota and Metabolite Profiles Associated With Functional Constipation Severity
Wang, J., He, J., Liu, D., Zhang, T., Wu, Y., & Xie, M. (2024) · Microbiology and Immunology · doi:10.1111/1348-0421.13187 · Cited by 10
Bifidobacterium longum subsp. longum relieves loperamide hydrochloride-induced constipation in mice by enhancing bile acid dissociation
Zhang, C., Wang, L., Liu, X., Wang, G., Zhao, J., & Chen, W. (2024) · Food & Function · doi:10.1039/d4fo04660a · Cited by 11
Weizmannia coagulans BC99 Relieves Constipation Symptoms by Regulating Inflammatory, Neurotransmitter, and Lipid Metabolic Pathways: A Randomized, Double-Blind, Placebo-Controlled Trial
Fan, Q., Gao, Y., Zhou, Y., Wu, J., Wang, H., Dong, Y., Gai, Z., Wu, Y., Fang, S., & Gu, S. (2025) · Foods · doi:10.3390/foods14040654 · Cited by 10
“Also, serum inflammatory cytokine levels are positively correlated with the severity of constipation [28].”
Poly-γ-glutamic acid alleviates slow transit constipation by regulating aquaporin and gut microbes
Wang, X., Zhou, J., Sun, Z., Jia, R., Huang, D., Tang, D., Xia, T., & Xiao, F. (2025) · Scientific Reports · doi:10.1038/s41598-025-92783-2 · Cited by 10
Postbiotics and extracellular polysaccharides of Lacticaseibacillus rhamnosus LRa05 alleviate loperamide-induced constipation via gut microbiota
Zhang, J., Wang, N., Yun, L., Fang, S., Zhao, Y., & Zhang, M. (2025) · Food Bioscience · doi:10.1016/j.fbio.2025.106651 · Cited by 9
Chronische Obstipation
Sailer, M. (2021) · Der Chirurg · doi:10.1007/s00104-021-01399-5 · Cited by 9
Analyzing fecal loading and retention patterns by abdominal X‐rays of hospitalized older adults: A retrospective study
Gau, J., Patel, P., Pan, J., & Kao, T. (2022) · Aging Medicine · doi:10.1002/agm2.12199 · Cited by 9
“In the current study, the RS segment was not included in the pattern analysis because: (1) this area serves as a storage site for stool readily for defecation; and”
Method
Explainable multi-modal deep learning with cross-modal attention for diagnosis of dyssynergic defecation using abdominal X-ray images and symptom questionnaire
Sangnark, S., Rattanachaisit, P., Patcharatrakul, T., & Vateekul, P. (2024) · IEEE Access · doi:10.1109/access.2024.3409077 · Cited by 8
“Nowadays, one of the most common gastrointestinal disorder symptoms is chronic constipation, which affects 10-15% of the worldwide population [1].”
Background
Pelvic floor physical therapy in patients with chronic anal fissure: long-term follow-up of a randomized controlled trial
van Reijn-Baggen, D. A., Elzevier, H. W., Putter, H., Pelger, R. C. M., & Han‐Geurts, I. J. M. (2023) · International Journal of Colorectal Disease · doi:10.1007/s00384-022-04292-7 · Cited by 8
Functional Constipation and Obstructed Defecation
O'Donnell, M. T., & Haviland, S. (2023) · Surgical Clinics of North America · doi:10.1016/j.suc.2023.11.007 · Cited by 8
Restore intestinal steady-state: new advances in the clinical management of chemotherapy-associated diarrhea and constipation
Chen, M., Li, Y., & Chen, P. (2025) · Journal of Molecular Histology · doi:10.1007/s10735-025-10367-w · Cited by 8
“The dry stool can cause anal fissures and hemorrhoids, while intestinal stool block accumulation can affect the absorption of chemotherapy drugs (Bharucha and Lacy 2020).”
Single-cell transcriptomics reveals the interaction between fibroblasts and activated immune cells: an exploratory bioinformatics study of pro-inflammatory mechanisms in slow transit constipation
Chi, F., Sun, W., Zhang, C., Yu, X., Huang, C., Ding, X., Chang, H., Gao, J., Yan, S., Zhu, A., et al. (2025) · International Journal of Surgery · doi:10.1097/js9.0000000000002415 · Cited by 9
“STC affects an estimated 2–4% of general population, often leading to persistent symptoms, significant psycho-social stress, a decreased quality of life, and increased health care expenditures [ 4 ] .”
Inadequate Propulsion and Pelvic Floor Relaxation in Dyssynergic Defecation: Insights From Synchronous Proctomanometry
Lamichhane, R., Gautam, M., Fletcher, J. G., Bailey, K. R., Chen, J., Feuerhak, K. J., & Bharucha, A. E. (2025) · Gastroenterology · doi:10.1053/j.gastro.2025.04.013 · Cited by 8
Self-citation
Olive Oil Solution of Volatile Oil from Citri Reticulatae Pericarpium Viride Alleviates Slow-Transit Constipation via Regulating SCF/c-Kit Signaling Pathway and Intestinal Flora
Zou, S., Xie, B., An, Z., Li, F., Cui, L., Zhang, Z.-H., Bu, W., & He, D.-D. (2025) · Drug Design, Development and Therapy · doi:10.2147/dddt.s517114 · Cited by 5
Oat Fiber Alleviates Loperamide-Induced Constipation in Mice by Modulating Intestinal Barrier Function
Shi, Y., Han, Y. K., Jiang, J., Wang, L., Li, Z., Sun, G., Wang, S., Liao, W., Xia, H., Pan, D., et al. (2025) · Nutrients · doi:10.3390/nu17152481 · Cited by 8
“As a common gastrointestinal disorder, constipation is characterized by specific intestinal symptoms, including difficult defecation, reduced defecation frequency, and dry stools [1].”
Impact of prebiotics and postbiotics in the management of constipation: Analysis of their differentiated modulation of intestinal microbiota
Culqui, D. R., Sanz, P. R., Sanchez, R. P., Miranda, M. Y. S., Cruz-López, C. Y. S., & Rodríguez, J. A. M. (2025) · Clinical Nutrition ESPEN · doi:10.1016/j.clnesp.2025.08.003 · Cited by 9
Effect of acupressure on alleviating constipation among inpatients with stroke during the acute phase: A randomized controlled trial
Nieh, H., Wu, P.-O., Ou, S.-F., Li, H.-P., & Chen, J. (2023) · Complementary Therapies in Clinical Practice · doi:10.1016/j.ctcp.2023.101801 · Cited by 8
Estrogen inhibits colonic smooth muscle contractions by regulating BKβ1 signaling
Wen, J., Zhao, Y., Huang, C., Li, S., Li, P., Zhou, Y., Yan, Z., & Zhang, G. (2023) · PLoS ONE · doi:10.1371/journal.pone.0294249 · Cited by 8
A Novel Herbal Composition Alleviates Functional Constipation, Reduces Gastrointestinal Transit Time, and Improves Bowel Function in Adults: A Double-Blind, Randomized Clinical Study
Singh, G., Dixit, I., Kalman, D., & Gogineni, N. T. (2024) · Journal of the American Nutrition Association · doi:10.1080/27697061.2024.2346073 · Cited by 9
Bifidobacterium animalis subsp. lactis TG11 ameliorates loperamide-induced constipation in mice by modulating gut microbiota
Ma, W., Zhao, Y., Liu, Y., Wang, Y., Yu, S., & Huang, L. (2025) · Frontiers in Microbiology · doi:10.3389/fmicb.2025.1525887 · Cited by 8
Bionic measurement of defecation in a swine model
Wang, Y., Sun, D., Han, L., & Wang, M. (2021) · Physiological Measurement · doi:10.1088/1361-6579/abe100 · Cited by 8
DIAGNOSIS AND MANAGEMENT OF CHRONIC IDIOPATHIC CONSTIPATION: A NARRATIVE REVIEW FROM A BRAZILIAN EXPERT TASK FORCE
Passos, M. D. C. F., Alvariz, R. C., ANDRÉ, E. A., Barbuti, R. C., Fillmann, H. S., MURAD-REGADAS, S. M., Filho, J. R., Perrotti, M., & GUEDES, L. S. (2022) · Arquivos de Gastroenterologia · doi:10.1590/s0004-2803.202200001-23 · Cited by 10

Authors: Bharucha, A. E., & Lacy, B. E.
Affiliations: Mayo Clinic (US)
Corresponding author: Bharucha, Adil E.
ORCID: Bharucha, Adil E.
Lacy, Brian E.
Venue: Gastroenterology
Publisher: Elsevier BV
Published: 2020-04
Volume: 158
Issue: 5
Pages: 1232-1249.e3
ISSN: 0016-5085 (ISSN-L)
DOI: 10.1053/j.gastro.2019.12.034
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
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
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

Mechanisms, Evaluation, and Management of Chronic Constipation

Abstract

Overview

Integrity signals

Verification

Claims the paper makes

Claims other papers make about this one

Self-check

Citations

Cites

Cited by

Related

Metadata

Record

About these checks