Constipation

Scope of the problem Expert consensus defines constipation as at least two of the following in any 12-week period in the previous 12 months (Rome Criteria): fewer than three bowel movements (BMs) per week; hard stool, a sense of incomplete evacuation, or excessive straining in more than 25% of BMs; a need for digital manipulation to facilitate evacuation. Patients perceive being constipated somewhat differently. They use the term to mean straining (81%), hard, pellet-like stools (72%), an inability to defecate when desired (34%), or infrequent defecation (33%). Whatever patients mean by constipation, it should be recognized as a symptom, not a diagnosis. The prevalence of constipation in the young adult population of industrialized nations is as high as 20%, rising to 30-40% in those over 65 years of age. Women are twice as likely to report constipation than men (18.3% vs. 9.2%), and much more likely to seek care for it (35.6% vs. 19.5%). At least 20% of the population habitually uses over-the-counter laxative preparations.