ASGE Annual GI Advanced Practice Provider Course (On-demand) (Day Two) | March 2026-Constipation and Pelvic Floor Disorders: Diagnostic and Imaging Approaches

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This presentation reviews evaluation and management of chronic constipation with emphasis on pelvic floor (defecatory) disorders. Constipation is defined functionally by infrequent bowel movements (about ≤3/week), hard stools, straining, and incomplete evacuation, and diagnostically using Rome IV criteria to distinguish chronic idiopathic constipation from IBS with constipation. Constipation affects about 12–20% of adults and is more common in women, older adults, and those with neurologic disease; it significantly impacts quality of life, increases healthcare use, and is often linked to pelvic floor dysfunction.<br /><br />Constipation is classified as primary (normal transit, slow transit, and defecatory disorders/pelvic floor dysfunction) or secondary (medication-induced, metabolic, neurologic, or structural causes such as hypothyroidism, Parkinson’s disease, and diabetes). Stool form can be categorized with the Bristol Stool Scale (constipation typically types 1–2).<br /><br />The talk outlines Rome IV criteria for functional constipation and functional defecation disorders (FDD). FDD diagnosis requires constipation/IBS-C plus evidence of impaired evacuation on at least two of three tests: balloon expulsion, anorectal manometry/anal surface EMG, or imaging. Subtypes include inadequate defecatory propulsion and dyssynergic defecation (inappropriate pelvic floor/anal contraction despite adequate propulsive forces).<br /><br />Recommended evaluation includes abdominal and digital rectal exams (tone, paradoxical contraction, masses, rectocele), basic labs (CBC, TSH, calcium, glucose), and targeted testing: abdominal x-ray, colonic transit studies (radiopaque markers/Sitz markers, scintigraphy, wireless motility capsule), anorectal manometry and balloon expulsion, and imaging such as defecography/MRI defecography; colonoscopy or CT may be used when indicated.<br /><br />Management starts with fiber and laxatives (OTC and prescription). For dyssynergic defecation, treatment includes laxatives plus pelvic floor therapy/biofeedback to retrain coordinated defecation.

Asset Subtitle

Jill Olmstead, DNP, ANP-BC, FAANP

Keywords

chronic constipation

pelvic floor dysfunction

defecatory disorders

Rome IV criteria

IBS with constipation (IBS-C)

Bristol Stool Scale

anorectal manometry

balloon expulsion test

colonic transit study (Sitz markers)

biofeedback therapy