Constipation
as a symptom
The
first point to recognize about constipation is that it is a symptom,
not a disease or a sign. This fact introduces a tension into
the investigation of constipation which is not present in the
investigation of some other symptoms, such as pain; namely the
fact that certain objectively measurable criteria exist which
can be taken to indicate the presence of constipation in an individual
or a population. These criteria may be insisted upon by drug regulatory
authorities, for instance, in adjudicating whether a new therapy
can be licensed for the treatment of constipation. However, particular
patients may complain of constipation when their symptoms do not
satisfy the criteria for the symptom.
Different
definitions of constipation
Doctors
and patients can mean different things when they talk about constipation.
Epidemiological
studies have shown that 95% (Drossman
et al., 1982) to 99% (Connell
et al., 1965) of a healthy population defecate at least three
times per week. These findings have informed what are sometimes
referred to as the "Rome criteria" (Drossman
et al., 1990), which are often used to define constipation.
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The
presence of two or more of the following symptoms
for at least three months:
- Straining
at least 25% of the time
- Hard
stools at least 25% of the time
- Incomplete
evacuation at least 25% of the time
- Two
or fewer bowel movements per week
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