![]() Thompson WG, Longstreth GF, Drossman DA, Heaton KW, Irvine EJ, Muller-Lissner SA. Geographic distribution of constipation in the United States. Clinical epidemiology of chronic constipation. Epidemiology of constipation (EPOC) study in the United States: relation of clinical subtypes to sociodemographic features. Stewart WF, Liberman JN, Sandler RS, Woods MS, Stemhagen A, Chee E, et al. Epidemiology of constipation in the United States. Physician visits in the United States for constipation: 1958 to 1986. Liquid: 45 mL, 90 mL (mix with 4 oz water, then follow with 8 oz water 8 Anorectal dysfunction may be an acquired behavioral disorder, or the process of defecation may not have been learned in childhood. 9 These patients are more likely to complain of a feeling of incomplete evacuation, a sense of obstruction, or a need for digital manipulation. 7 Anorectal dysfunction is the inefficient coordination of the pelvic musculature in the evacuation mechanism. ![]() 8 The causes for slow transit constipation are unclear the postulated mechanisms include abnormalities of the myenteric plexus, defective cholinergic innervation, and anomalies of the noradrenergic neuro-muscular transmission system. 7 Patients may complain of abdominal bloating and infrequent bowel movements. Slow transit constipation is characterized by prolonged delay in the passage of stool through the colon. In patients with functional constipation, stool passes through the colon at a normal rate. Normal transit constipation, also known as functional constipation, is the most common. Primary causes of constipation can be classified into three groups: normal transit constipation, slow transit constipation, and anorectal dysfunction. Alternative treatment methods such as biofeedback and surgery may be considered for these patients. ![]() If constipation is refractory to medical treatment, further diagnostic evaluation may be warranted to assess for colonic transit time and anorectal dysfunction. Fiber and laxatives increase stool frequency and improve symptoms of constipation. There are a variety of over-the-counter and prescription laxatives available for the treatment of constipation. Management of chronic constipation includes keeping a stool diary to record the nature of the bowel movements, counseling on bowel training, increasing fluid and dietary fiber intake, and increasing physical activity. ![]() Empiric treatment may be tried initially for patients with functional constipation. Functional constipation is diagnosed when no secondary causes can be identified, such as a medical condition or a medicine with a side effect profile that includes constipation. Although constipation is not a physiologic consequence of normal aging, decreased mobility and other comorbid medical conditions may contribute to its increased prevalence in older adults. Constipation is a common complaint in older adults. ![]()
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