Diagnostic criteria for constipation 2 or more of the following

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1. Fewer than 3 bowel movements/week.

2. Excessive straining during bowel movements.

3. A feeling of incomplete evacuation after bowel movements.

4. Passage of hard or pellet-like stools.

B. Clinical evaluation

1. The time of onset of constipation, stool frequency and consistency, the degree of straining, a sensation of complete or incomplete evacuation should be determined.

2. Chronic suppression of the urge to defecate contributes to constipation. Determine the amount of fiber and fluid consumed. Obstetric, surgical and drug histories, history of back trauma or neurologic problems should be assessed.

C. Physical examination

1. A palpable colon with stool in the left lower quadrant may be detected, although the examination is often normal. Gastrointestinal masses should be sought. Perianal inspection may reveal skin excoriation, skin tags, anal fissures, anal fistula, or hemorrhoids.

2. Rectal examination may reveal a mass or stool. Resting and squeeze sphincter tone should be assessed. When the patient is asked to bear down as if to defecate, relaxation of anal tone and perineal descent should be palpable. The absence of anal relaxation or inadequate perineal descent, raises the suspicion of obstructive defecation.

D. Laboratory evaluation. A complete blood cell count, glucose, calcium, phosphate, thyroid function test, calcium, stool examination for ova and parasites, occult blood, and flexible sigmoidoscopy may be indicated to exclude organic causes.

E. Secondary causes of constipation

1. Fissure in ano, hemorrhoids, fistulas, ischiorectal abscess, colonic neoplasms, hypothyroidism, hypercalcemia, diabetes, Hirschsprung's disease, Parkinson's disease, multiple sclerosis, or cerebrovascular disease may cause constipation.

2. Inadequate fiber intake commonly causes constipation.

3. Drugs that cause constipation include opiate analgesics, aluminum-containing antacids, iron and calcium supplements, antidiarrheals, antihistamines, antidepressants, antiparkinson agents, and calcium channel blockers.

4. If secondary causes have been excluded, the most likely cause is idiopathic constipation related to a disorder of colorectal motility.

II. Empiric management of constipation

A. Behavioral modification. The patient should be encouraged to heed the urge to defecate and not suppress it. Patients should establish a regular pattern of moving their bowels at the same time every day, usually in the morning, after breakfast. Daily exercise is advised.

B. Fiber. The patient should be placed on a diet of 20-30 g of dietary fiber per day. Fiber must be taken with ample fluids, otherwise constipation may worsen.

C. Laxatives and nonessential drugs should be discontinued.






Metamucil (regular)

1 tsp


Metamucil (orange flavor or sugar-free)

1 tsp


Citrucel (orange flavor or sugar-free)

1 tbsp


Fiberall Natural Flavor

1 tsp



Recommended Dose








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Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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