Constipation pathophysiology

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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]


About 1.5 liter fluid enters the colon from small intestine every day. Colon only excrete out 200-400 mL stool. The defecation process consist of three important stages, include filling of the rectum, sensation of rectum fullness, and relaxation of pelvic floor muscles in a coordinated fashion. Primary constipation is caused by anorectal and colonic problems, while secondary constipation is caused by organic and metabolic diseases or medications. Diseases that disturb the nervous system may lead to constipation, such as diabetes mellitus, autonomic neuropathy, Chagas' disease, and Hirschsprung's disease. Chronic use of the laxative may lead to melanosis coli, which is identified by hyperpigmentation and brownish discoloration of colonic mucosa. The primary histopathological finding in melanosis coli is brown granular pigment in lamina propria.


Colonic Function



Primary constipation

Secondary constipation

Group Drug Alternatives
Antihypertensives Clonidine
Calcium channel blockers
Ganglionic blockers
Antidepressants Tricyclic antidepressants
Cation-containing drugs Oral iron supplementation
Aluminum-containing drugs Sucralfate
Analgesics Opiates
  • Replaced with other groups
Vinca alkaloids


  • Genetic studies have shown the role of genetics in childhood constipation by various mechanisms.
  • Genes involved in the pathogenesis of childhood constipation and related diseases are as following:[24]
Group Gene OMIM/Chromosome Syndrome Other manifestations
Autonomic nervous system GFAP 203450/17q21 Alexander disease
LMNB1 169500/5q23 Cavitating leukodystrophy – autonomic failure
PHOX2B 209880/4p12 Congenital central hypoventilation syndrome
HSN2 201300/12p13 Hereditary sensory and autonomic neuropathy type II and III
IKBKAP 223900/9q31
MECP2 300005/Xq28 MECP2 duplication
SCN9A 167400/2q24 Paroxysmal extreme pain disorder
TCF4 610954/18q21 Pitt-Hopkins syndrome
NRXN1 610954/2p16.3
Innervation ATRX 301040/Xq13 Alpha-thalassemia mental retardation syndrome
RET 162300/10q11 MEN2B
ZEB2 235730/2q22 Mowat-Wilson syndrome
HPSE2 236730/10q24 Ochoa syndrome
Muscular COL4A5 308940/Xq22 Alport syndrome with diffuse leiomyomatosis
PTRF-CAVIN 613327/17q21 Congenital generalized lipodystrophy, type 4
DES 601419/2q35 Desmin-related myopathy
SCN4A 170500/17q23 Hyperkalemic periodic paralysis (HYPP)
  • Episodic flaccid generalized muscle weakness
ZNF9 160900/3q21 Myotonic dystrophy
DMPK 602668/19q13
SMN1 253300/5q12 Spinal muscular atrophy
AXPC1 609033/1q31 Posterior column ataxia with retinitis pigmentosa
CBP 180849/16p13 Rubinstein-Taybi syndrome
EP300 180849/22q13
HUWE1 300706/Xp11 Turner mental retardation syndrome
UPF3B 300676/Xq25 X-linked syndromic mental retardation -14
Electrolyte disturbance SLC12A3 263800/16q13 Gitelman syndrome
SLC6A8 300036/Xq28 Creatinine transporter defect
CASR 239200/3q21 Hyperparathyroidismneonatal familial
AVPR2 304800/Xq28 Nephrogenic diabetes insipidus
SPINK5 256500/5q32 Netherton syndrome
Malformation HLXB9 176450/7q36 Currarino syndrome
MED12 305450/Xq13 FG syndrome
FLNA 305450/Xq28
SIX3 157170/2p21 Holoprosencephaly
VANGL1 600145/1p13 Sacral defect with anterior meningocele

Associated Conditions

Associated conditions with constipation are included:

Gross Pathology

  • On gross pathology, there is no finding related to constipation.

Microscopic Pathology

Melanosis coli with brown granular pigments, By Ed Uthman from Houston, TX, USA - Uploaded by CFCF, CC BY 2.0,
Melanosis coli, By myself (Alex_brollo) - Slide files from Hospital of Monfalcone (Italy), CC BY-SA 3.0,
Melanosis coli in laxative abusing patient, By Ed Uthman from Houston, TX, USA - Melanosis coliUploaded by CFCF, CC BY 2.0,


  1. 1.0 1.1 Sleisenger, Marvin (2010). Sleisenger and Fordtran's gastrointestinal and liver disease : pathophysiology, diagnosis, management. Philadelphia: Saunders/Elsevier. ISBN 9781437727678.
  2. 2.0 2.1 Andrews CN, Storr M (2011). "The pathophysiology of chronic constipation". Can J Gastroenterol. 25 Suppl B: 16B–21B. PMC 3206564. PMID 22114753.
  3. Southwell BR, Clarke MC, Sutcliffe J, Hutson JM (2009). "Colonic transit studies: normal values for adults and children with comparison of radiological and scintigraphic methods". Pediatr. Surg. Int. 25 (7): 559–72. doi:10.1007/s00383-009-2387-x. PMID 19488763.
  4. Dinning PG, Smith TK, Scott SM (2009). "Pathophysiology of colonic causes of chronic constipation". Neurogastroenterol. Motil. 21 Suppl 2: 20–30. doi:10.1111/j.1365-2982.2009.01401.x. PMC 2982774. PMID 19824935.
  5. Grundy D, Al-Chaer ED, Aziz Q, Collins SM, Ke M, Taché Y, Wood JD (2006). "Fundamentals of neurogastroenterology: basic science". Gastroenterology. 130 (5): 1391–411. doi:10.1053/j.gastro.2005.11.060. PMID 16678554.
  6. Bharucha AE (2006). "Pelvic floor: anatomy and function". Neurogastroenterol. Motil. 18 (7): 507–19. doi:10.1111/j.1365-2982.2006.00803.x. PMID 16771766.
  7. Rao SS (2010). "Advances in diagnostic assessment of fecal incontinence and dyssynergic defecation". Clin. Gastroenterol. Hepatol. 8 (11): 910–9. doi:10.1016/j.cgh.2010.06.004. PMC 2964406. PMID 20601142.
  8. Rao SS, Camilleri M, Hasler WL, Maurer AH, Parkman HP, Saad R, Scott MS, Simren M, Soffer E, Szarka L (2011). "Evaluation of gastrointestinal transit in clinical practice: position paper of the American and European Neurogastroenterology and Motility Societies". Neurogastroenterol. Motil. 23 (1): 8–23. doi:10.1111/j.1365-2982.2010.01612.x. PMID 21138500.
  9. Longstreth GF, Thompson WG, Chey WD, Houghton LA, Mearin F, Spiller RC (2006). "Functional bowel disorders". Gastroenterology. 130 (5): 1480–91. doi:10.1053/j.gastro.2005.11.061. PMID 16678561.
  10. Ashraf W, Park F, Lof J, Quigley EM (1996). "An examination of the reliability of reported stool frequency in the diagnosis of idiopathic constipation". Am. J. Gastroenterol. 91 (1): 26–32. PMID 8561138.
  11. Cash BD, Chey WD (2005). "Review article: The role of serotonergic agents in the treatment of patients with primary chronic constipation". Aliment. Pharmacol. Ther. 22 (11–12): 1047–60. doi:10.1111/j.1365-2036.2005.02696.x. PMID 16305718.
  12. Preston DM, Lennard-Jones JE (1986). "Severe chronic constipation of young women: 'idiopathic slow transit constipation'". Gut. 27 (1): 41–8. PMC 1433176. PMID 3949236.
  13. Bassotti G, Roberto GD, Sediari L, Morelli A (2004). "Toward a definition of colonic inertia". World J. Gastroenterol. 10 (17): 2465–7. PMC 4572142. PMID 15300885.
  14. He CL, Burgart L, Wang L, Pemberton J, Young-Fadok T, Szurszewski J, Farrugia G (2000). "Decreased interstitial cell of cajal volume in patients with slow-transit constipation". Gastroenterology. 118 (1): 14–21. PMID 10611149.
  15. Tzavella K, Riepl RL, Klauser AG, Voderholzer WA, Schindlbeck NE, Müller-Lissner SA (1996). "Decreased substance P levels in rectal biopsies from patients with slow transit constipation". Eur J Gastroenterol Hepatol. 8 (12): 1207–11. PMID 8980942.
  16. Rao SS, Ozturk R, Laine L (2005). "Clinical utility of diagnostic tests for constipation in adults: a systematic review". Am. J. Gastroenterol. 100 (7): 1605–15. doi:10.1111/j.1572-0241.2005.41845.x. PMID 15984989.
  17. 17.0 17.1 Rao SS (2008). "Dyssynergic defecation and biofeedback therapy". Gastroenterol. Clin. North Am. 37 (3): 569–86, viii. doi:10.1016/j.gtc.2008.06.011. PMC 2575098. PMID 18793997.
  18. Fosnes GS, Lydersen S, Farup PG (2011). "Constipation and diarrhoea - common adverse drug reactions? A cross sectional study in the general population". BMC Clin Pharmacol. 11: 2. doi:10.1186/1472-6904-11-2. PMC 3049147. PMID 21332973.
  19. Simonson W, Han LF, Davidson HE (2011). "Hypertension treatment and outcomes in US nursing homes: results from the US National Nursing Home Survey". J Am Med Dir Assoc. 12 (1): 44–9. doi:10.1016/j.jamda.2010.02.009. PMID 21194659.
  20. Dolder C, Nelson M, Stump A (2010). "Pharmacological and clinical profile of newer antidepressants: implications for the treatment of elderly patients". Drugs Aging. 27 (8): 625–40. doi:10.2165/11537140-000000000-00000. PMID 20658791.
  21. Talley NJ, Jones M, Nuyts G, Dubois D (2003). "Risk factors for chronic constipation based on a general practice sample". Am. J. Gastroenterol. 98 (5): 1107–11. doi:10.1111/j.1572-0241.2003.07465.x. PMID 12809835.
  22. Rosti G, Gatti A, Costantini A, Sabato AF, Zucco F (2010). "Opioid-related bowel dysfunction: prevalence and identification of predictive factors in a large sample of Italian patients on chronic treatment". Eur Rev Med Pharmacol Sci. 14 (12): 1045–50. PMID 21375137.
  23. Takahashi T, Matsuda K, Kono T, Pappas TN (2003). "Inhibitory effects of hyperglycemia on neural activity of the vagus in rats". Intensive Care Med. 29 (2): 309–11. doi:10.1007/s00134-002-1580-3. PMID 12594591.
  24. Peeters B, Benninga MA, Hennekam RC (2011). "Childhood constipation; an overview of genetic studies and associated syndromes". Best Pract Res Clin Gastroenterol. 25 (1): 73–88. doi:10.1016/j.bpg.2010.12.005. PMID 21382580.

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