Young women with a sluggish bowel
Our ancestors who were by no means fools regarded a daily bowel action as necessary. While the efforts made to procure this caused various harm, the lack of concern in these enlightened times also gives rise to some problems.
Neither frequency nor quantity defines constipation and in the absence of disturbance to the patient these should be carefully left alone.
However, some people, of whom all or most are female, complain of episodic abdominal discomfort, nausea and on examination have a full and often tender descending colon with gurgling and increased bowel sounds.
In the visibly healthy person, dietary enquiry and advice may be all that is required. If the problem persists then first exclude significant conditions (Hypothyroidism, obscure tropical diseases (absent in those who have not travelled), congenital atony such as Hirschsprung's) by means of enquiry and sufficient blood tests to be persuasive. Consider and hopefully dismiss psychological factors - a history of childhood sexual abuse is said to be more common but this is not diagnostic of it. Rectal examination may hint at this, as well as ruling out painful anal conditions.
Initially clearing the bowel should produce an improvement. This only works if the patient takes the same view of the conditition's cause as the doctor. Once the colon is no longer palpably full, encouragement to eat more fibre and drink more water, with occasional use of aperients should maintain it.