Diagnosis of constipation in primary and secondary care.

The evaluation of chronic constipation involves a careful delineation of its duration and characteristics as well as a physical examination including neurologic, anorectal, and perineal assessment. In patients who fail to respond to fiber supplements or simple laxatives, diagnostic studies such as barium radiography, rectal biopsy, and colonic transit studies may be warranted. Studies of defecation and anorectal function may be useful in those who complain of excessive straining or who use digital manipulation to facilitate evacuation. Most patients, however, do not require diagnostic studies beyond a careful history and physical examination, and are easily managed in the primary care setting.