Clinical features

People with constipation can be divided into two main categories: those with difficulty defecating (but normal bowel motion frequency) and those with a transit abnormality (which can present as infrequent defecation) (1).

The clinical features of constipation include:

• infrequent, incomplete evacuation of stools - generally this is taken to be less than twice a week; however, normal bowel habit is less than two bowel motions per week for some. More significant is the change in bowel habit relative to the patient's normal bowel habit.
• anorexia and vague abdominal discomfort
• diarrhoea - constipation may cause overflow or spurious diarrhoea, especially in the elderly, when faecal fluid intermittently escapes past an impacted faecal mass
• acute abdominal pain - usually in children - or features of intestinal obstruction - usually in the elderly
• on examination, there may be mild abdominal tenderness and a faecally-loaded colon on the left side. There is usually a mass of faeces felt on rectal examination. In elderly patients, faeces may be impacted higher up and so an empty rectum does not exclude constipation.

Reference:

1. Mueller-Lissner SA, Wald A. Constipation in adults. BMJ Clin Evid. 2010 Jul 5;2010:0413. PMID: 21418672; PMCID: PMC3217654.