People mean many things when they say they have constipation. The infrequent passing of stools, difficulties in voiding, sense of incomplete voiding are all suggestive of constipation. The normal reference range for bowel movements is very varied. Some people have bowel movements three times a day; others, only one or two times a week.
Medically, constipation is defined as fewer than three bowel movements in a week. Constipation may be considered severe when there is less than one bowel movement in a week.
A proper clinical history and physical examination usually suffice to diagnose constipation.
The presence of hard stools, difficulty in eliminating them and feeling of incomplete voiding of stools usually indicate the presence of constipation. Very hard, small, pellet-like stools which are eliminated with a lot of difficulties certainly indicate constipation even if stool occurs every day.
In very severe constipation of long standing, a physical examination may reveal the presence of hard lumps over the abdominal surface.