J Neurogastroenterol Motil.  2023 Jul;29(3):271-305. 10.5056/jnm23066.

2022 Seoul Consensus on Clinical Practice Guidelines for Functional Constipation

  • 1Division of Gastroenterology, Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Chungcheongnam-do, Korea
  • 2Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
  • 3Division of Gastroenterology, Department of Internal Medicine, Dankook University Hospital, Cheonan, Chungcheongnam-do, Korea
  • 4Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
  • 5Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
  • 6Department of Internal Medicine, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea
  • 7Division of Gastroenterology, Department of Internal Medicine, CHA University Ilsan Medical Center, CHA University School of Medicine, Ilsan, Gyeonggi-do, Korea
  • 8Division of Gastroenterology and Hepatology, Department of Internal Medicine, College of Medicine, Kyung Hee University, Seoul, Korea
  • 9Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Gyeonggi-do, Korea
  • 10Department of Radiology, Konkuk University School of Medicine, Seoul, Korea
  • 11Department of Internal Medicine, Chosun University Hospital, Gwangju, Korea
  • 12Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, Changwon, Gyeongsangnam-do, Korea
  • 13Department of Internal Medicine, College of Medicine, Hallym University, Chuncheon, Gangwon-do, Korea
  • 14Division of Gastroenterology, Department of Internal Medicine, Biomedical Research Institute, Jeonbuk National University Hospital, Jeonju, Jeollabuk-do, Korea
  • 15Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
  • 16Department of Surgery, The Catholic University of Korea, St. Vincent's Hospital, Suwon, Gyeonggido, Korea
  • 17Division of Colon and Rectal Surgery, Korea University Ansan Hospital, Ansan, Gyeonggi-do, Korea
  • 18Division of Healthcare Technology Assessment Research, National Evidence-Based Healthcare Collaborating Agency, Seoul, Korea
  • 19Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
  • 20Department of Gastroenterology, Digestive Research Disease Institute, Wonkwang University School of Medicine, Iksan, Jeollabuk-do, Korea


Chronic constipation is one of the most common digestive diseases encountered in clinical practice. Constipation manifests as a variety of symptoms, such as infrequent bowel movements, hard stools, feeling of incomplete evacuation, straining at defecation, a sense of anorectal blockage during defecation, and use of digital maneuvers to assist defecation. During the diagnosis of chronic constipation, the Bristol Stool Form Scale, colonoscopy, and a digital rectal examination are useful for objective symptom evaluation and differential diagnosis of secondary constipation. Physiological tests for functional constipation have complementary roles and are recommended for patients who have failed to respond to treatment with available laxatives and those who are strongly suspected of having a defecatory disorder. As new evidence on the diagnosis and management of functional constipation emerged, the need to revise the previous guideline was suggested. Therefore, these evidence-based guidelines have proposed recommendations developed using a systematic review and meta-analysis of the treatment options available for functional constipation. The benefits and cautions of new pharmacological agents (such as lubiprostone and linaclotide) and conventional laxatives have been described through a meta-analysis. The guidelines consist of 34 recommendations, including 3 concerning the definition and epidemiology of functional constipation, 9 regarding diagnoses, and 22 regarding managements. Clinicians (including primary physicians, general health professionals, medical students, residents, and other healthcare professionals) and patients can refer to these guidelines to make informed decisions regarding the management of functional constipation.


Constipation; Diagnosis; Guideline; Meta-analysis; Therapeutics
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