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A panel of gastroenterologists from five countries has proposed a working definition for “occasional constipation” that recognizes the wide variation in symptoms and patient perceptions of a problem they say is often overlooked by clinicians and researchers.

Definitions of constipation mainly focus on chronic constipation, and often use a stool frequency threshold, such as fewer than 3 bowel movements per week. However, this fails to recognize the wide variation in the “normal” frequency of bowel movements, they point out.

There is “an emerging recognition” that occasional constipation is another subtype that falls outside current classifications, write Satish S.C. Rao, hydroxyzine pam medication MD, PhD, Digestive Health Center, Medical College of Georgia, Augusta University, and colleagues.

The “working” definition they propose encompasses stool frequency, difficulty with stool passage, individual perception, symptom(s) duration, and potential response to treatment.

Specifically, it states:

“Occasional constipation can be defined as intermittent or occasional symptomatic alterations in bowel habit, in the absence of warning signs for more serious conditions. The symptoms include a bothersome reduction in the frequency of bowel movements and/or difficulty with passage of stools. These symptoms may last a few days or a few weeks, and may require modification of lifestyle, dietary habits and/or use of over-the- counter laxatives or bulking agents to restore a satisfactory bowel habit.”

Rao and colleagues say this definition is meant to be “practical” and “user-friendly.”

They also hope it will stimulate further discussion, debate, and refinement in the wider gastroenterology community.

The panel’s report was published online this month in the American Journal of Gastroenterology.

“Reasonable” Definition

Christine Lee, MD, a gastroenterologist at the Cleveland Clinic, Cleveland, Ohio, told Medscape Medical News, the definition is “reasonable. It portrays bowel disorders as a continuum and acknowledges that variations in perception make ‘normal’ stool hard to standardize.”

Lee, who wasn’t part of the panel, said this definition “aligns” with what she sees in her clinical practice.

“How patients discern symptoms, patients’ level of threshold to actuate concern, and patients’ ability to adapt/cope varies widely from person to person,” she said. “Occasional constipation affects people in differing degrees and therefore the definition needs to be pliable and inclusive.”

“When treating patients with occasional constipation, one needs to be open minded,” Lee advised. “When making treatment recommendations, physicians must consider patient perception and objective evidence.”

The published paper was developed based on input from the authors who initiated and participated in an expert consensus meeting supported by Sanofi. The authors received an honorarium to participate in the meeting. Medical writing support for the development of this manuscript, under the direction of the authors, was provided by Ian C Grieve, PhD, of Ashfield MedComms, an Inizio company, and was funded by Sanofi. Rao and several authors have disclosed relationships with Sanofi and other pharmaceutical companies. Lee reports no relevant financial relationships.

Am J Gastroenterol. Published online August 12, 2022. Abstract

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