Constipation: Diagnostic Criteria, Causes, Home Remedies, and When to See a Doctor

Constipation is more than infrequent bowel movements—it's a symptom complex defined by Rome IV criteria and with diverse etiologies.

Diagnostic Criteria (Rome IV)

≥2 of the following for ≥3 months (onset ≥6 months prior):

• Straining >25% of defecations
• Lumpy/hard stools (Bristol 1–2) >25%
• Sensation of incomplete evacuation >25%
• Sensation of anorectal obstruction >25%
• Manual maneuvers needed >25%
• <3 spontaneous bowel movements/week

Common Causes

• Dietary: Low fiber, inadequate fluids.
• Medications: Opioids, anticholinergics, calcium channel blockers, iron, aluminum antacids.
• Lifestyle: Sedentary, ignoring urge, travel.
• Medical: IBS-C, hypothyroidism, diabetes, hypercalcemia, Parkinson's, spinal cord injury.
• Structural: Colorectal cancer, stricture, rectocele, pelvic floor dyssynergia.

Red Flags (Alarm Symptoms)

• Age >50 new onset
• Rectal bleeding/melena
• Unintentional weight loss
• Family history CRC/IBD
• Anemia
• Nocturnal symptoms

Management: Stepwise Approach

1. Fiber (25–35 g/day: psyllium, fruits, vegetables) + fluids.
2. Osmotic laxatives (PEG 3350, lactulose, magnesium).
3. Stimulants (senna, bisacodyl) short-term.
4. Secretagogues (linaclotide, plecanatide) for IBS-C/CIC.
5. Prokinetics (prucalopride).
6. Biofeedback for dyssynergia.

When to Refer

Persistent symptoms despite lifestyle/OTC measures require colonoscopy referral—especially with red flags. Don't normalize chronic constipation; it's treatable and may signal serious pathology.