Ongoing Issues in Proper Diagnosis of Constipation

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Various surveys report the incidence of constipation to range from 2 to 30%, with one large international survey pegging the number at 12% worldwide. The numbers encompass a wide range and probably reflect fundamental problems in the survey method itself. However, the bottom line is that constipation is a common condition that afflicts a substantial fraction of the population.

The uncertainty of survey results stems partly from the fact that defining constipation is difficult. For example, asked what a normal frequency for passage of stool is, the average person might reply anywhere from every day to every three days. Furthermore, many will complain about other types of symptoms associated with constipation, such as hard feces, or very slow expulsion when sitting on the toilet seat. Such variations confound the interpretation of statistics, giving rise to numbers as low as 2% and as high as 30%.

After diagnosis, the patient and the physician must still face the task of trying to determine the fundamental cause of constipation. For some, the constellation of symptoms might suggest something such as irritable bowel syndrome (IBS). For others, incomplete control of muscles in the rectum due to trauma or injury can be a source of constipation. Yet for the largest group, there is no clear cause. This last group are classified into the “idiopathic” group.

With idiopathic and chronic constipation, one of the first things a physician will do with his or her patient is inquire about dietary and personal bowel habits. The physician wishes to rule out the simplest causes. Dietary shortage of insoluble fiber can be fixed by increasing uptake of fiber, either through food intake modification or addition of supplements. This type of natural treatment has the advantage of both provide diagnosis and treatment, if successful.

Other types of natural treatments include both lubricant laxatives and herbal supplements such as senna. Herbal and natural supplements are not always safe. The FDA has banned some natural supplements, namely aloe vera and cascara recently, for failure on the part of manufacturers to provide sufficient safety data. However, some other over-the-counter treatments remain available.

Physician-prescribed constipation pharmaceuticals are another option. These include conventional laxatives as well as advanced chemicals that have specific effects on certain functions of the colonic tract. More recently, novel and interesting therapies such as biofeedback training have been investigated for efficacy in medical studies. The state of the art is expected to evolve quickly.

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