Evaluating Chronic Constipation

Chronic constipation affects nearly 1 in 5 adults in the United States and can significantly interfere with daily life. While occasional constipation is common, symptoms that last longer than two months may indicate a chronic condition that should be evaluated by a healthcare professional.

People experience constipation differently—some have fewer than three bowel movements per week, while others struggle with incomplete emptying or alternating loose stools. Because chronic constipation can have multiple causes, proper medical evaluation is important.

You’re Not Alone

If chronic constipation is affecting your quality of life, help is available. A medical professional can work with you to identify possible causes and develop a personalized plan to improve symptoms and restore comfort and confidence.

How Rectal Expulsion Device (RED<) Testing Can Help

RED is a quick, in-office screening test that helps your provider determine whether your pelvic floor muscles may be contributing to constipation. These muscles play a critical role in bowel movements by relaxing and contracting to allow stool to pass.

If the pelvic floor muscles are weak or poorly coordinated, constipation medications alone may not be effective. RED testing helps guide treatment so your provider can choose the most appropriate approach—whether that’s medication, pelvic floor physical therapy, or both.

Why Pelvic Floor Health Matters

The pelvic floor supports organs in the lower body and helps control bowel movements. When these muscles don’t function properly, it can lead to ongoing constipation. Pelvic floor physical therapy focuses on improving muscle strength, coordination, and endurance, as well as supporting surrounding connective tissues, offering a long-term solution for some patients.

Understanding RED Test Results

  • Very fast emptying (under 5 seconds): May suggest weak pelvic floor muscles. Physical therapy may be recommended.
  • Normal emptying (5–120 seconds): Pelvic floor muscles are likely not the cause. Your provider may adjust or change medications.
  • Delayed or no emptying (over 2 minutes): May indicate poor muscle coordination or weakness. Pelvic floor physical therapy may help.

How RED Supports and Enhances the ARM Experience

  • Convenient in-office screening: RED can be performed during the initial clinic visit and does not require bowel preparation or an enema.
  • Complements ARM testing: Rapid results help determine whether a patient is an appropriate candidate for pelvic floor physical therapy or if additional ARM testing is needed.
  • Helpful referral tool: RED allows general gastroenterology providers to screen patients before referring them to a specialized ARM program.
  • Improved patient follow-through: Patients who undergo RED testing are more likely to participate in recommended treatment, including ARM and pelvic floor therapy appointments.
  • More physiologic testing: The proprietary RED balloon simulates the natural sensation of stool, providing more meaningful results than traditional air- or water-filled balloons and helping predict response to therapy.
  • Greater efficiency: Because sensation and expulsion are assessed during RED, less time is required to complete ARM testing.
  • Separate billing: RED is billed independently from ARM.
  • Insurance coverage: Some insurance may cover this service. Although we don’t bill insurance we can provide you with a SuperBill to submit to your insurance for possible reimbursement.