Functional Constipation

Constipation is a common health complaint.  Queensland Health report constipation affects 1 in 5 Australians at some point during their life.  It can be transient and resolve with simple strategies, such as increasing daily water intake and dietary fibre.  For some individuals, constipation can become chronic and complex.  It can create other health concerns and decrease quality of life.

Many people may be unaware that they are constipated.  Below are the Rome IV Criteria for identifying and diagnosing functional constipation. 

        Diagnostic criteria*

Must include two or more of the following:**

  1. Straining during more than ¼ (25%) of defecations
  2. Lumpy or hard stools (Bristol Stool Form Scale 1-2) more than ¼ (25%) of defecations
  3. Sensation of incomplete evacuation more than ¼ (25%) of defecations
  4. Sensation of anorectal obstruction/blockage more than ¼ (25%) of defecations
  5. Manual maneuvers to facilitate more than ¼ (25%) of defecations (e.g., digital evacuation, support of the pelvic floor)
  6. Fewer than three SBM per week
  7. Loose stools are rarely present without the use of laxatives
  8. Insufficient criteria for irritable bowel syndrome

*Criteria fulfilled for the last 3 months with symptom onset at least 6 months prior to diagnosis

**For research studies, patients meeting criteria for opioid-induced constipation (OIC) should not be given a diagnosis of FC because it is difficult to distinguish between opioid side effects and other causes of constipation.  However, clinicians recognize that these two conditions may overlap.

Pelvic floor Physiotherapists often work with patients where their primary health complaint is constipation.  We would usually start with a detailed interview to identify the symptoms, timeline and contributing factors.  A physical examination is often indicated, as well as the patient completing a bowel diary for the course of >2 weeks.  This combination of information allows your therapist to tailor your specific treatment program to resolve your bothersome symptoms and improve quality of life.

If you are experiencing symptoms of constipation, we encourage you to open the conversation with your Doctor.  You do not need a referral to see us; however, it can be helpful to have had a medical review to rule out sinister causes before commencing conservative management options.  There are many treatment options available; so if you are sitting there, reading and identifying with these issues, we hope to see you in the clinic soon!