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Jamshed 2011): Straining with at least 25% of bowel movements Lumpy or hard stools at least 25% of the time Sensation of incomplete emptying with at least 25% of bowel movements Sensation of an anal or rectal blockage with at least 25% of bowel movements The use of hands or fingers to facilitate at least 25% of bowel movements Fewer than three bowel movements per week Diagnostic tests are recommended if an underlying condition, such as hypothyroidism, may be a contributing factor