Knowles et al developed a scoring system for evaluating a patient with consitpation. The authors are from St. Bartholomew's, Royal London School of Medicine and Dentistry, Queen Mary and Westfield College and the Royal College of Surgeons of England.
Patient selection: constipation (age range not specified)
Parameters:
(1) duration of constipation
(2) laxative use
(3) frequency of bowel movement
(4) unsuccessful evacuatory attempts
(5) feeling incomplete evacuation
(6) abdominal pain
(7) bloating
(8) enemas/digitation
(9) time taken in minutes in the lavatory per attempt
(10) difficulty evacuating (with painful effort)
(11) stool consistency without laxatives
|
Parameter |
Finding |
Points |
|
duration of constipation |
< 18 months |
0 |
|
|
18 months to 5 years |
1 |
|
|
5 to 10 years |
2 |
|
|
10 to 20 years |
3 |
|
|
> 20 years |
4 |
|
laxative use |
none |
0 |
|
|
prn or for short period |
1 |
|
|
regular, long duration |
2 |
|
|
long duration, ineffective |
3 |
|
frequency of bowel movements |
1 to 2 times every 1 to 2 days |
0 |
|
|
<= 2 times per week |
1 |
|
|
< 1 per week |
2 |
|
|
< 1 every 2 weeks |
3 |
|
unsuccessful evacuatory attempts |
never or rarely |
0 |
|
|
occasionally |
1 |
|
|
usually |
2 |
|
|
always, manual evacuation |
3 |
|
feeling incomplete evacuation |
never |
0 |
|
|
rarely |
1 |
|
|
occasionally |
2 |
|
|
usually |
3 |
|
|
always |
4 |
|
abdominal pain |
never |
0 |
|
|
rarely |
1 |
|
|
occasionally |
2 |
|
|
usually |
3 |
|
|
always |
4 |
|
bloating |
never |
0 |
|
|
perceived by patient only |
1 |
|
|
visible to others |
2 |
|
|
severe with nausea or satiety |
3 |
|
|
severe with vomiting |
4 |
|
enemas or digitation |
none |
0 |
|
|
occasional enema or suppository |
1 |
|
|
regular enema or suppository |
2 |
|
|
manual occasional |
3 |
|
|
manual always |
4 |
|
time taken |
< 5 minutes |
0 |
|
|
5 to 10 minutes |
1 |
|
|
10 to 30 minutes |
2 |
|
|
> 30 minutes |
3 |
|
difficulty evacuating |
never |
0 |
|
|
rarely |
1 |
|
|
occasionally |
2 |
|
|
usually |
3 |
|
|
always |
4 |
|
stool consistency |
soft, loose, normal |
0 |
|
|
occasionally hard |
1 |
|
|
always hard |
2 |
|
|
always had, usually pellet-sized |
3 |
where:
• Usually is >= 50% of the time but not always. Rarely is < 25% of the time.
total score =
= SUM(points for all 11 parameters)
Interpretation:
• minimum total score: 0
• maximum total score: 11
• The higher the score the worse the constipation.
• Patients without constipation had scores in the range of 0 to 6.
Performance:
• A score >= 10 has 100% sensitivity and 100% specificity for constipation.
Specialty: Gastroenterology
