Complete the patient survey categories to visualize the cumulative Wexner constipation index.
Guidelines & Evidence
Clinical Details
Section 1
When to Use
When to Use
Quantifying the severity of chronic constipation
Evaluating the impact of constipation on quality of life
Measuring pre- and post-therapeutic outcomes for surgical or medical interventions (e.g., biofeedback or secretagogues)
Philosophy of the Score
The Wexner (or Agachan) Constipation Score provides an objective numerical value for a highly subjective symptom. It covers frequency, difficulty, and the mechanical assistance required for evacuation.
Section 2
Formula & Logic
The 8 Assessment Items (0–30 pts)
01
Frequency of bowel movements.
02
Difficulty (straining).
03
Completeness (feeling of incomplete evacuation).
04
Pain (Abdominal).
05
Time per attempt (minutes).
06
Assistance Type (Laxatives/Digital/Enema).
07
Failure of evacuation (attempts per 24h).
08
Duration of symptoms (years).
Thresholds
0 Points
Normal function
15+ Points
Severe Constipation
30 Points
Maximum Severity
Section 3
Pearls/Pitfalls
The "Mechanical" Marker
One of the most valuable aspects of the Wexner score is the inclusion of "Assistance." Patients requiring digital maneuvers or frequent enemas (scoring high in the assistance domain) are highly likely to have Pelvic Floor Dyssynergia or Obstructive Defecation Syndrome rather than simple slow-transit constipation.
Surgical Screening
In patients considering a subtotal colectomy for slow-transit constipation, a high pre-operative Wexner score is required to justify the morbidity of surgery. However, if the score is driven purely by "straining" without slow transit, surgery will likely fail.
Clinical Pearls
A score > 15 is often considered the threshold for "significant impact" on quality of life
The score correlates well with Colonic Transit Time (CTT) studies
It should be used alongside the Rome IV criteria to distinguish between Functional Constipation and IBS-C
Section 4
Next Steps
Management Action
01
Score > 15: Perform Anorectal Manometry (ARM) and Balloon Expulsion Test to rule out outlet obstruction.
02
Score < 8: Trial of high-fiber diet and osmotic laxatives.
Complementary Scoring
Rome IV Criteria (Constipation)
ARM Interpreter (Manometry)
Bristol Stool Scale
Section 5
Evidence Appraisal
The Foundational Score
A constipation scoring system to simplify evaluation and management of constipated patients.
Agachan F et al. • Diseases of the Colon & Rectum. 1996;39(6):681-5. The original study developing and validating the 0-30 scale.
Developed by the Colorectal Surgery department at the Cleveland Clinic. Led by Steven Wexner, the group sought to move beyond "vague" bowel diaries to a structured clinical instrument that could predict surgical success.
