The Constipation Scoring System (CSS) is used to evaluate the prevalence and severity of constipation [21]. The scoring system contains eight variables: frequency of bowel movement, difficult or painful evacuation, completeness of evacuation, abdominal pain, time per attempt, use and type of assistance (including laxatives, digitations, or enemas), number of unsuccessful attempts at evacuation in a 24-h period, and duration of constipation. The CSS consists of seven items scored on a 5-point Likert scale from 0 (none of the time) to 4 (all of the time), and one item (use and type of assistance) rated on a 0–2 scale. The total score can range from 0 (normal) to 30 (severe constipation), and a cutoff score of 15 suggests constipation.

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