Constipation in adults — structured viva

Structured oral on adult constipation: Rome IV definition and prevalence numbers, alarm-feature discipline, the dietary foundation per BDA guidance, the laxative ladder with trial data, dyssynergia and biofeedback, opioid-induced constipation, slow-transit disease and the depression link.

Prompt

The examiner opens: 'A 50-year-old woman says she has been constipated for years and wants something stronger than her herbal tablets. Take me through your assessment.' The viva branches through definition and prevalence, alarm exclusion, diet evidence, the laxative ladder, dyssynergia, opioids and special populations.

Stem

You are the GP. The patient has self-managed with herbal preparations for years; the examination and history are yours to structure before any prescription changes hands. ^[9]

References12Show

[10]Youn JW, Joo H, Kim S et al. Global Prevalence of Functional Constipation Across All Age Groups According to Rome II-IV Criteria, 1999-2025: A Systematic Review and Meta-Analysis. Clinical and translational gastroenterology, 2026.PMID 41919745
[6]Vlismas LJ, Wu W, Ho V Idiopathic Slow Transit Constipation: Pathophysiology, Diagnosis, and Management. Medicina (Kaunas, Lithuania), 2024.PMID 38256369
[9]Dimidi E, van der Schoot A, Barrett K et al. British Dietetic Association Guidelines for the Dietary Management of Chronic Constipation in Adults. Neurogastroenterology and motility, 2025.PMID 41081381
[5]Li H, Zhang P, Xue Y A comparison of the safety and efficacy of polyethylene glycol 4000 and lactulose for the treatment of constipation in pregnant women: a randomized controlled clinical study. Annals of palliative medicine, 2020.PMID 33302648
[2]Camilleri M, Piessevaux H, Yiannakou Y et al. Efficacy and Safety of Prucalopride in Chronic Constipation: An Integrated Analysis of Six Randomized, Controlled Clinical Trials. Digestive diseases and sciences, 2016.PMID 27056037
[3]Black CJ, Burr NE, Quigley EMM et al. Efficacy of Secretagogues in Patients With Irritable Bowel Syndrome With Constipation: Systematic Review and Network Meta-analysis. Gastroenterology, 2018.PMID 30144426
[12]Tu Y, Zhou Z, Li Y et al. Efficacy of biofeedback therapy for chronic constipation in adults: a systematic review and meta-analysis of randomized controlled trials. Frontiers in medicine, 2026.PMID 42292261
[1]Chiarioni G, Heymen S, Whitehead WE Biofeedback therapy for dyssynergic defecation. World journal of gastroenterology, 2006.PMID 17131466
[7]Portincasa P, Luglio CV, Sozzi S et al. Opioid-induced constipation in internal medicine: recognition and management pathways. Internal and emergency medicine, 2025.PMID 40877716
[11]Ren ZY, Guo ZY, Diao Q et al. Constipation is associated with an increased risk of depression: A systematic review and meta-analysis of observational studies. Translational psychiatry, 2026.PMID 42230550
[4]Deb B, Prichard DO, Bharucha AE Constipation and Fecal Incontinence in the Elderly. Current gastroenterology reports, 2020.PMID 32839874
[8]Preechakawin N, Maneerattanaporn M, Geeratragool T et al. Role of Prucalopride in the Treatment of Chronic Constipation in Parkinson Disease: A Randomized Controlled Trial. The American journal of gastroenterology, 2026.PMID 41002195

Constipation in adults — structured viva

Stem

You are the GP. The patient has self-managed with herbal preparations for years; the examination and history are yours to structure before any prescription changes hands. ^[9]

References12Show

[10]Youn JW, Joo H, Kim S et al. Global Prevalence of Functional Constipation Across All Age Groups According to Rome II-IV Criteria, 1999-2025: A Systematic Review and Meta-Analysis. Clinical and translational gastroenterology, 2026.PMID 41919745
[6]Vlismas LJ, Wu W, Ho V Idiopathic Slow Transit Constipation: Pathophysiology, Diagnosis, and Management. Medicina (Kaunas, Lithuania), 2024.PMID 38256369
[9]Dimidi E, van der Schoot A, Barrett K et al. British Dietetic Association Guidelines for the Dietary Management of Chronic Constipation in Adults. Neurogastroenterology and motility, 2025.PMID 41081381
[5]Li H, Zhang P, Xue Y A comparison of the safety and efficacy of polyethylene glycol 4000 and lactulose for the treatment of constipation in pregnant women: a randomized controlled clinical study. Annals of palliative medicine, 2020.PMID 33302648
[2]Camilleri M, Piessevaux H, Yiannakou Y et al. Efficacy and Safety of Prucalopride in Chronic Constipation: An Integrated Analysis of Six Randomized, Controlled Clinical Trials. Digestive diseases and sciences, 2016.PMID 27056037
[3]Black CJ, Burr NE, Quigley EMM et al. Efficacy of Secretagogues in Patients With Irritable Bowel Syndrome With Constipation: Systematic Review and Network Meta-analysis. Gastroenterology, 2018.PMID 30144426
[12]Tu Y, Zhou Z, Li Y et al. Efficacy of biofeedback therapy for chronic constipation in adults: a systematic review and meta-analysis of randomized controlled trials. Frontiers in medicine, 2026.PMID 42292261
[1]Chiarioni G, Heymen S, Whitehead WE Biofeedback therapy for dyssynergic defecation. World journal of gastroenterology, 2006.PMID 17131466
[7]Portincasa P, Luglio CV, Sozzi S et al. Opioid-induced constipation in internal medicine: recognition and management pathways. Internal and emergency medicine, 2025.PMID 40877716
[11]Ren ZY, Guo ZY, Diao Q et al. Constipation is associated with an increased risk of depression: A systematic review and meta-analysis of observational studies. Translational psychiatry, 2026.PMID 42230550
[4]Deb B, Prichard DO, Bharucha AE Constipation and Fecal Incontinence in the Elderly. Current gastroenterology reports, 2020.PMID 32839874
[8]Preechakawin N, Maneerattanaporn M, Geeratragool T et al. Role of Prucalopride in the Treatment of Chronic Constipation in Parkinson Disease: A Randomized Controlled Trial. The American journal of gastroenterology, 2026.PMID 41002195