Constipation is a topic covered in the Washington Manual of Medical Therapeutics.

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General Principles


Constipation consists of infrequent and incomplete bowel movements, which can be associated with straining and passage of pellet-like stools.


  • Recent changes in bowel habits may suggest an organic cause, whereas long-standing constipation is more likely to be functional.
  • Medications (e.g., calcium channel blockers, opiates, anticholinergics, iron supplements, barium sulfate) and systemic diseases (e.g., diabetes mellitus, hypothyroidism, systemic sclerosis, myotonic dystrophy) may contribute.
  • Female gender, older age, lack of exercise, low caloric intake, low-fiber diet, and disorders that cause pain on defecation (e.g., anal fissures, thrombosed external hemorrhoids, pelvic floor dyssynergia) are other risk factors.1

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