Carrying out a holistic assessment of a patient with constipation

Constipation is a common problem that can occur at any age. The incidence rate is 2-3 times higher in women than in men and prevalence increases with age; however, it is important to note that this may be underestimated due to the high proportion of self-management and treatment (National Institute for Health and Care Excellence (NICE), 2017). Constipation is more common in pregnancy and can be exacerbated by medication. Effective treatment of constipation relies on a thorough holistic assessment to identify the cause.

Constipation is defined as unsatisfactory defecation due to the infrequent passing of stools (NICE, 2017). It is a subjective disorder and is measured in patients according to their dissatisfaction with the frequency of defecation and the relevance of the symptoms to the individual (Woodward, 2012; Basilisco and Coletta, 2013; Dougherty and Lister, 2015). However, there can be wide variation between different individuals' perceptions of ‘normal’. Consequently, this has led to a lack of consensus around constipation definition (Kyle, 2011; Dougherty and Lister, 2015). The Rome IV diagnostic criteria for gastrointestinal disorders identify constipation as two of the following criteria in the preceding month: a spontaneous bowel movement that occurs less than 3 times a week, painful or hard stools, presence of faecal matter in the rectum, or a history of incomplete evacuation (Drossman, 2016). Chronic constipation is defined as symptoms that persist for more than 12 weeks in 6 months (NICE, 2017).