What is chronic functional constipation?

A functional gastrointestinal disorder in which constipation predominates is called chronic functional constipation. ROME II criteria for functional constipation include at least 12 weeks, which need not be consecutive, in the preceding 12 months of two or more of:

1.  Straining with over one-fourth of defecations
2.  Lumpy or hard stools with over one-fourth of defecations
3.  Sensation of incomplete evacuation of the rectum with over one-fourth of defecations
4.  Sensation of obstruction/blockage of the anus or rectum with over one-fourth of defecations
5.  Use of manual maneuvers to facilitate over one-fourth of defecations (e.g., using fingers around or in the rectum or vagina to help get the stool out of the rectum)
6.  Less than three defecations per week.

There are two points to stress regarding the criteria for chronic functional constipation. First, having fewer than 3 bowel movements per week alone is not sufficient for the diagnosis. It is necessary to have at least one other problem. Second, it is possible to have chronic functional constipation and three or more bowel movements per week.

Also called chronic idiopathic constipation, or chronic constipation, people with functional constipation experience persistent symptoms of constipation (typically lasting 6 months or more), and their symptoms are not caused by another medical disorder. It is estimated that as much as 20% of the U.S. population experiences chronic constipation. Similar to irritable bowel syndrome (IBS), altered levels of serotonin may play a role in chronic constipation.

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Some people experience constipation that persists for years or decades, even though they have no physical abnormality of the bowel on x-ray studies (such as barium enema examinations) or colonoscopy. This condition -- known as chronic severe constipation, functional constipation, or chronic idiopathic constipation -- is rare, but is more common in women.

The Rome III criteria for a diagnosis of functional constipation state that patients must have experienced two or more of the following symptoms for the past three months, and that symptoms must have begun at least six months before diagnosis:

• straining during at least one out of four bowel movements
• having lumpy or hard stools during at least one out of four bowel movements
• having a sensation of incomplete evacuation in at least one out of four bowel movements
• having a sensation that your rectum or anus is blocked during at least one out of four bowel movements
• resorting to manual maneuvers such as using a finger to help facilitate movement during at least one out of four bowel movements
• fewer than three defecations a week