• Functional constipation (constipation occurring in the absence of a demonstrated pathologic condition) involves the presence of at least two of the following symptoms: straining, lumpy or hard stools, sensation of incomplete evacuation, sensation of anorectal obstruction or blockage, need for manual maneuvers to facilitate defecation, and/or infrequent bowel movements (fewer than 3 per week).

• Other complaints may include painful or difficult defecation, bloating, and absence of loose stools.

• Alarm (or red flag) symptoms include worsening of constipation, blood in the stools, weight loss, fever, anorexia, nausea, and vomiting.

• The patient should seek medical attention when symptoms are severe, last longer than 3 weeks, are disabling, when alarm symptoms occur, or whenever a significant change in usual bowel habits occurs.

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