The Curbsiders Internal Medicine Podcast #314 Constipation: When the Flow Won’t Go with Dr. Iris Wang
Jan 3, 2022
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Essential Bowel Habit Questions
- Ask about baseline frequency, Bristol stool form, straining, incomplete evacuation, positional changes and digital maneuvers when assessing constipation.
- If multiple signs of outlet dysfunction are present, perform a focused rectal exam to evaluate for rectal evacuation disorder.
Three Constipation Phenotypes
- Chronic constipation maps into normal-transit, slow-transit, and defecatory (outlet) disorders with differing prevalence.
- Rectal evacuation disorders account for ~25% and slow transit for ~13% of cases.
Test The Outlet Before The Colon
- Before colon transit testing, always rule out pelvic floor dysfunction with anorectal manometry and balloon‑expulsion testing.
- If anorectal tests are inconclusive, proceed to defecography to look for pelvic organ prolapse or outlet obstruction.