Common Signs Of Constipation - How To Test For It

How can I test for constipation??

Since constipation can be secondary to many common health conditions, the first step is to gain an understanding of a very detailed history regarding an individual's onset and duration of their symptoms with difficulty defecating (1).

Common CC Diagnosis Testing

Digital rectal examination

Stool diary

Colonic and anorectal tests

• If primary cause constipation is suspected, you must localize the problem to identify if it is either to the colon or to the anorectum. This is typically done with a colonic transit test (3). For this, the most common way is to use radiopaque capsule markers that are ingested and five days later, an x-ray is taken. The markers are counted and at that time, a 20% or more retention of the markers is considered abnormal (3).

Defecography and MR defecography

Anorectal manometry

Balloon expulsion test

Colonic transit assessment

Wireless motility capsule test

Colonic manometry 

• Methane gas production - will slow down gut transit leading to constipation
• Previous studies have shown that the presence of methanogens is associated with chronic constipation and methane production after a carbohydrate challenge and its prevalence is higher in chronic constipation with slow colonic transit as compared to those with normal transit (even though stool characteristics were similar in both groups) [26]. Methane production correlated with colonic transit, suggesting an association with stool transport but not with stool characteristics.
• Look for food sensitivities - gluten, egg, dairy, soy, rice

• Colonoscopy
• Complete stool analysis - test microbiome to establish all of the markers for healthy digestion / bowel movements
• Other digestive issues

Assessment of Constipation: 

Review Past Medical History, Review of Symptoms, and alarm features 

Risk factors associated with constipation

Age

There is a gradual increase in constipation rates with advancing age after 50 and an even more dramatic increase in individuals over the age of 70 years old (3). There is a demographic shift occurring in the United states population, as the population becomes more elderly, individuals are more likely to be living with chronic neurologic disease, and more likely to reside in nursing homes. Therefore, we can expect rates of constipation to increase dramatically. This makes it even more important to understand the natural history of CC, associated healthcare resources, and the specific quality of life issues in individuals suffering from this disorder (3).

Gender

In adults, studies demonstrated CC is approximately 2.2-fold more frequent in women than in men (3). However, constipation definitions had an effect on this ratio, as studies that used strict Rome criteria found less dramatic differences while self-reported constipation was 2.65-fold more common in women. This suggests that Rome criteria does not identify all of the symptoms that women (more often than men) define as constipation (3). We will visit the Rome criteria below.

Socioeconomic status

It is more prevalent in those with lower socioeconomic classes and lower educational levels, although these differences seem to be magnified in studies when constipation is defined by self-reported individuals (3).

Lifestyle habits

With lifestyle habits, the prevalence of CC is associated with decreased liquid intake. This is a common associated trend and was also supported in more than 10K adults in the National Health and Nutrition Examination Survey in 2013 (11). Other lifestyle factors of constipation include decreased physical activity in both men and women and constipation results in a U-shaped curve with dietary fiber intake, indicating that extremes, lower fiber intake and higher fiber intakes, may result in an increased risk for constipation (11).

Health conditions

Constipation may also be a secondary health issue to other diseases. Individuals with certain health problems such as colon (stricture, cancer, anal fissure, proctitis), metabolic disturbances (hpyercalcemia, hypothyroidism, diabetes mellitus), and/or neurologic disorders (spinal cord lesions, parkinsons) are more likely to be constipated (13).

Medications or supplement use

With many medications (narcotic pain, blood pressure, psychiatric medications, etc.), a common side effect may cause constipation (15).

With limited epidemiological studies on CC, there needs to be additional studies to determine why certain risk factors inducing race, gender, socioeconomic status, and age are associated with increased risk for CC. Further studies may also help to identify further symptoms and classification criteria for sub-types of CC (4).

Questions to ask with your healthcare practitioner

Suggested questions to identify and evaluate if an individual has chronic constipation:

• How many bowel movements do you have per week?
• Do you strain when attempting defecation?
• What is the consistency of your stools?
• Do you have to use fingers or certain positions to help you have a bowel movement?
• Following a bowel, do you feel that you have completely evacuated your bowels?
• How long have you had these symptoms for?
• If symptoms started suddenly, was there a reason or event that may have affected symptom onset?
• What prescription, over-the-counter (OTC), and/or herbal medications have you tried to relieve constipation symptoms?
• Do you have any blood in your stools?
• Have you experienced any unintentional weight loss of 10lbs or more?
• Do you have a family history of colon cancer or inflammatory bowel disease?