Chronic Idiopathic Constipation

Diagnosis, lifestyle/OTC therapies, and prescription management — ACG-AGA 2023 Guidelines.

Diagnosis & Classification

Rome IV criteria, subtypes

Chronic Idiopathic Constipation (CIC)

CIC affects ~16% of the global population and is one of the most common GI conditions in clinical practice.

Rome IV Criteria for CIC (≥2 of the following for ≥6 months)

Straining in >25% of defecations

Lumpy or hard stools (BSFS 1–2) in >25%

Sensation of incomplete evacuation in >25%

Sensation of anorectal blockage in >25%

Manual maneuvers to facilitate defecation in >25%

<3 spontaneous bowel movements/week

Loose stools rarely without laxatives

Insufficient criteria for IBS-C

Normal Transit

Most common. Normal colon transit time. Often associated with dietary factors.

Slow Transit

Delayed colonic transit. Associated with reduced colonic motility. May need prucalopride.

Defecatory Disorder

Dyssynergic defecation or outlet obstruction. Requires anorectal manometry + biofeedback.

Alarm Features — Rule Out Structural Disease

Perform colonoscopy if: rectal bleeding, iron deficiency anemia, unintentional weight loss, family history of CRC, age ≥45 (overdue for CRC screening), or acute-onset constipation in older patient. Constipation alone without alarms does not require routine colonoscopy.

Chey WD et al. ACG-AGA Guideline: Pharmacological Management of Chronic Idiopathic Constipation. Am J Gastroenterol. 2023.