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Despite
the Rome criteria, people have their own personal definition of
what it means to be constipated. It is useful to compare and contrast
the components of the Rome criteria with the views of various
patient populations.
Constipation
and time requirements
The
Rome criteria were intended to clarify the diagnosis of functional
constipation in an essentially healthy population.
When constipation is an accompaniment of illness, the time
requirement, in particular, becomes less appropriate. No other
symptom is approached in this way: relief is not offered for pain
or breathlessness only after it has been endured for at least
three months. In addition to the unnecessary suffering that this
would cause, this period would be a substantial fraction of the
life expectancy of many palliative care patients.
Hence
an approach to the definition of constipation that is appropriate
in a gastroenterology clinic results in denying the existence
of constipation in most palliative care patients, even though
constipation has been found to be a greater cause of distress
than pain in this group (Holmes,
1989). The key is the identity of constipation as a symptom,
whose presence or absence is defined by the patient, not
the doctor.
Thus,
while a proposed definition of constipation in palliative care
is "the passage of small hard feces infrequently and with difficulty",
it is for the patient to define how infrequently
and with how much difficulty. Indeed, there are
other still more subjective sensations that together suggest to
the individual that they are constipated and which are even harder
to capture in any tight, quantitative definition for research
purposes. We may wish to measure bowel movement frequency and
other parameters of intestinal function that can be expressed
numerically, but alongside them must be included a measure which
allows patients to express the extent to which they perceive
themselves to be constipated (see Subjective
Measurement of Constipation).
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