Constipation history and symptoms

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Eiman Ghaffarpasand, M.D. [2]


A positive history of straining, hard stools, sensation of incomplete evacuation, sensation of anorectal obstruction, use of manual maneuvers, and less than 3 defecations weekly is suggestive of constipation. The most common symptoms of constipation include infrequent bowel movements, abdominal bloating, necessity to strain, and anal pain. Less common symptoms of constipation include abdominal fullness, visible abdominal distention, incomplete evacuation, abdominal pain, rectal bleeding, and mass protrusion. Bristol Stool Form Scale and Patient Assessment Constipation-Quality of Life (PAC-QOL) are two questionnaire based on patients symptoms, help to diagnose constipation and quality of life in constipated patients.

History and Symptoms


Patients with constipation may have a positive history of:[1]

Specific areas of focus when taking history of patients with constipation include:[2]

Bristol Stool Scale- By Cabot Health, via Wikimedia Commons[3]

Common Symptoms

Common symptoms of constipation include:[4]

Bristol Stool Form Scale

  • The Bristol Stool Form Scale is a tool to investigate the stool form and it helps to identify the colonic transit time.
  • Very hard stools may reflect the highest and watery stools may reflect the lowest colonic transit time.[5]

Patient Assessment Constipation-Quality of Life (PAC-QOL)

  • Patient Assessment Constipation-Quality of Life (PAC-QOL) is a questionnaire to evaluate the quality of life of patients with constipation.
  • PAC-QOL is completely based on the common symptoms of the patients with constipation.[6]

Less Common Symptoms

Less common symptoms of constipation include:[7]


  1. Rao, Satish S. C. (2008). "Approach to the Patient with Constipation": 373–398. doi:10.1002/9781444300758.ch20.
  2. Rao SS, Meduri K (2011). "What is necessary to diagnose constipation?". Best Pract Res Clin Gastroenterol. 25 (1): 127–40. doi:10.1016/j.bpg.2010.11.001. PMC 3063397. PMID 21382584.
  3. <> [CC BY-SA 3.0 <>]
  4. Koch A, Voderholzer WA, Klauser AG, Müller-Lissner S (1997). "Symptoms in chronic constipation". Dis. Colon Rectum. 40 (8): 902–6. PMID 9269805.
  5. Heaton KW, O'Donnell LJ (1994). "An office guide to whole-gut transit time. Patients' recollection of their stool form". J. Clin. Gastroenterol. 19 (1): 28–30. PMID 7930429.
  6. Marquis P, De La Loge C, Dubois D, McDermott A, Chassany O (2005). "Development and validation of the Patient Assessment of Constipation Quality of Life questionnaire". Scand. J. Gastroenterol. 40 (5): 540–51. doi:10.1080/00365520510012208. PMID 16036506.
  7. Mertz, H.; Naliboff, B.; Mayer, E. A. (1999). "Symptoms and physiology in severe chronic constipation". The American Journal of Gastroenterology. 94 (1): 131–138. doi:10.1111/j.1572-0241.1999.00783.x. ISSN 0002-9270.

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