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Common Signs Of Constipation - How To Test For It

It is really important to determine whether you actually have constipation or a more serious health issue. So in this article, we're going to look at all the different tools you can discuss with your healthcare practitioner for finding an accurate answer. Let's go!

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Table of Contents

    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 

    History

    • Frequency of bowel movements
    • Stool form and consistency
    • Feelings of incomplete evacuation
    • Presence of abdominal pain
    • Need for adjunctive maneuvers such as straining abdominal pressure, digital manipulation, manual disimpaction
    • Diet and exercise habits
    • Use of laxatives

    Review of symptoms

    • Cold intolerance, weight gain, skin or hair changes
    • Vomiting or diuretic use
    • History of kidney stones, muscle weakness or confusion
    • Neurologic or cognitive disturbances such as tremors, memory loss
    • Gastroesophageal reflux or dysphagia
    • Change or dose adjustments of home medications
    • Recent travel

    Alarm features 

    • Sudden change in bowel habits or stool caliber
    • Age >50 years
    • Gastrointestinal bleeding (overt or occult)
    • Weight loss
    • Anemia
    • Nausea, vomiting or obstructive symptoms

     

    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).

    Section Summary:

    • Constipation may be more common than you think, constipation makes up a range of 2% to 34% of the general adult population globally, 42 million in the United States alone.
    • Increase CC risk factors include:
      • 50 years old, with a more dramatic increased prevalence over the age of 70
      • Women
      • Non-caucasian populations
      • Low socioeconomic status
      • Limited fluid consumption
      • Limited or very high dietary fiber intakes
      • Lack of physical activity
      • Health conditions such as colon, metabolic disturbances, and neurologic disorders
      • Specific medication side effects
    • More studies are needed to better understand risk factors associated with increased risk for CC which will additionally help to define symptoms and subtype classifications of CC.

    Questions to ask

    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?

    Evidence Based

    An evidence hierarchy is followed to ensure conclusions are formed off of the most up-to-date and well-designed studies available. We aim to reference studies conducted within the past five years when possible.

    • Systematic review or meta-analysis of randomized controlled trials
    • Randomized controlled trials
    • Controlled trials without randomization
    • Case-control (retrospective) and cohort (prospective) studies
    • A systematic review of descriptive, qualitative, or mixed-method studies
    • A single descriptive, qualitative, or mixed-method study
    • Studies without controls, case reports, and case series
    • Animal research
    • In vitro research

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    References

    1. Rao SSC, Rattanakovit K, Patcharatrakul T. Diagnosis and management of chronic constipation in adults. Nature reviews.Gastroenterology & hepatology. 2016;13(5):295-305. https://search.proquest.com/scholarly-journals/diagnosis-management-chronic-constipation-adults/docview/1785215334/se-2?accountid=34512. doi:http://dx.doi.org/10.1038/nrgastro.2016.53.
    2. Brandt LJ, Prather CM, Quigley EMM, Schiller LR, Schoenfeld P, Talley NJ. Systematic Review on the Management of Chronic Constipation in North America. Am J Gastroenterol. 2005;100:S5-S21. https://search.proquest.com/scholarly-journals/systematic-review-on-management-chronic/docview/1783683665/se-2?accountid=34512. doi:http://dx.doi.org/10.1111/j.1572-0241.2005.50613_2.x.
    3. Andrews CN, Storr M. The pathophysiology of chronic constipation. Can J Gastroenterol. 2011;25 Suppl B(Suppl B):16B-21B. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3206564/