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Health Protocols



A diagnosis of constipation is generally based on bowel habits, duration and severity of symptoms, and medical history. A digital rectal examination may also be indicated (Rao 2014).

A specific set of criteria known as Rome III is widely used for diagnosing functional gastrointestinal disorders, including constipation and constipation-predominant irritable bowel syndrome (IBS-C) (Drossman 2006). According to Rome III, constipation symptoms for at least six months along with two or more of the following criteria for at least three months constitutes chronic constipation (Leung, Riutta 2011; Jamshed 2011):

  • Straining with at least 25% of bowel movements
  • Lumpy or hard stools at least 25% of the time
  • Sensation of incomplete emptying with at least 25% of bowel movements
  • Sensation of an anal or rectal blockage with at least 25% of bowel movements
  • The use of hands or fingers to facilitate at least 25% of bowel movements
  • Fewer than three bowel movements per week

Diagnostic tests are recommended if an underlying condition, such as hypothyroidism, may be a contributing factor. Further testing, including a complete blood count and endoscopy, may be indicated for people who have one or more “alarm features” in their history or physical exam (Rao 2014; Jamshed 2011):

  • rectal bleeding
  • positive occult blood (microscopic traces of blood in the stool)
  • iron-deficiency anemia
  • unintended weight loss of 10 pounds or more
  • symptoms of obstruction
  • recent onset of symptoms (especially in an older individual)
  • rectal prolapse
  • change in stool diameter
  • family history of colon cancer
  • age older than 50