# Agachan constipation scoring system Agachan constipation score Status: LIVE Price: $0.005 USDC `GET /api/calc/wexner_constipation` HTML: https://magentlab.com/docs/wexner-constipation Markdown: https://magentlab.com/docs/wexner-constipation.md Not a medical device. Not a diagnosis, dose, or listing recommendation. ## What it computes Sum the eight Agachan 1996 constipation scoring system items from caller-assigned published table bands and return the 0-30 total and whether score > 15. ## When to use When an agent already has the eight Agachan 1996 table bands assigned and needs the published 0-30 constipation score. magent does not take a bowel history. Not Jorge 1993 fecal incontinence scoring, not Rome, and not a laxative order. ## When not to use - Not a medical device. - Not a laxative order. magent does not prescribe laxatives, enemas, or digital assistance. - Not fecal incontinence scoring. This is Agachan 1996 constipation scoring system, not Jorge 1993 fecal incontinence / CCF-FIS. - The caller assigns the eight published table bands. magent does not take a bowel history. - Agachan 1996 derivation patients all scored more than 15. constipation is true iff score > 15. Score 0 is the published normal pole; 30 is the published maximum. magent does not return Rome or ODS-only extra bands. ## Formula ``` wexner_constipation = frequency + painful_evacuation + incomplete_evacuation + abdominal_pain + time_per_attempt + assistance + unsuccessful_attempts + duration; Agachan 1996 eight-item constipation scoring system; frequency, painful_evacuation, incomplete_evacuation, abdominal_pain, time_per_attempt, unsuccessful_attempts, and duration each 0-4; assistance 0-2; max 30; constipation iff score > 15 ``` ## Citation [A constipation scoring system to simplify evaluation and management of constipated patients](https://doi.org/10.1007/BF02056950) Agachan F, Chen T, Pfeifer J, Reissman P, Wexner SD Dis Colon Rectum. 1996;39(6):681-685 DOI: [10.1007/BF02056950](https://doi.org/10.1007/BF02056950) ## Worked example ### All lowest published bands Given: `abdominal_pain=never, assistance=without_assistance, duration=0, frequency=1_2_times_per_1_2_days, incomplete_evacuation=never, painful_evacuation=never, time_per_attempt=less_than_5, unsuccessful_attempts=never` 1. Each item is the published 0 pole (frequency 1-2 times per 1-2 days; never for painful, incomplete, and abdominal pain; time less than 5 minutes; without assistance; never unsuccessful; duration 0 years) 2. Score = 0 (max 30); constipation false (Agachan 1996 cut is score > 15) ### Four items at published maxima Given: `abdominal_pain=always, assistance=without_assistance, duration=0, frequency=less_than_once_per_month, incomplete_evacuation=always, painful_evacuation=always, time_per_attempt=less_than_5, unsuccessful_attempts=never` 1. frequency less_than_once_per_month → 4; painful_evacuation always → 4; incomplete_evacuation always → 4; abdominal_pain always → 4; remaining items 0 2. Score = 16 (max 30); constipation true (score > 15) ## Also searched as - Wexner constipation score - Agachan constipation score - constipation scoring system - Agachan 1996 CSS - Wexner constipation - Agachan CSS - constipation score Agachan ## Parameters - `frequency` (string, required): Caller-assigned Agachan 1996 frequency of bowel movements. 1_2_times_per_1_2_days (1-2 times per 1-2 days) scores 0; 2_times_per_week scores 1; once_per_week scores 2; less_than_once_per_week scores 3; less_than_once_per_month scores 4. magent does not take a bowel history. - `painful_evacuation` (string, required): Caller-assigned Agachan 1996 painful evacuation effort. never scores 0; rarely 1; sometimes 2; usually 3; always 4. magent does not take a bowel history. - `incomplete_evacuation` (string, required): Caller-assigned Agachan 1996 feeling of incomplete evacuation. never scores 0; rarely 1; sometimes 2; usually 3; always 4. magent does not take a bowel history. - `abdominal_pain` (string, required): Caller-assigned Agachan 1996 abdominal pain. never scores 0; rarely 1; sometimes 2; usually 3; always 4. magent does not take a bowel history. - `time_per_attempt` (string, required): Caller-assigned Agachan 1996 minutes in lavatory per attempt. less_than_5 scores 0; 5_10 scores 1; 10_20 scores 2; 20_30 scores 3; more_than_30 scores 4. magent does not time the attempt. - `assistance` (string, required): Caller-assigned Agachan 1996 type of assistance. without_assistance scores 0; stimulative_laxatives scores 1; digital_assistance_or_enema scores 2. This item is 0-2 in that table, not 0-4. magent does not order laxatives, enemas, or digital assistance. - `unsuccessful_attempts` (string, required): Caller-assigned Agachan 1996 unsuccessful attempts for evacuation per 24 hours. never scores 0; 1_3 scores 1; 3_6 scores 2; 6_9 scores 3; more_than_9 scores 4. Adjacent printed ranges overlap; the caller assigns the published band. magent does not take a bowel history. - `duration` (string, required): Caller-assigned Agachan 1996 duration of constipation in years. 0 scores 0; 1_5 scores 1; 5_10 scores 2; 10_20 scores 3; more_than_20 scores 4. Adjacent printed ranges overlap; the caller assigns the published band. magent does not take a bowel history. ## Bulk (POST) POST the same path with a JSON items array. The first item is the GET unit; each additional item is $0.002. Invalid items return HTTP 400 before settlement. Method: `POST /api/calc/wexner_constipation` Max items: 25 Price: unit_amount + extra_item_amount * (n - 1) (unit 5000 atomic, extra 2000 atomic) Status: PREVIEW - 1 to 25 items. Each item uses the same keys as the GET query parameters. - POST of 1 item costs the same as GET. Lists longer than 25: chunk into multiple POSTs. Extra items still execute; do not pad dummy rows. - The first invalid item fails the whole request (index in the 400 JSON). You are not charged. - HTTP 200 is {count, path, items}. Each items[i] is the GET 200 body for that row. - Catalog misses (empty matches, found=false) stay paid 200s inside that slot. - x402 resource URL is this path plus n and body_sha256. Browsers that prefer text/html get the same paywall as GET; Pay retries POST with the same items. Example request: ```json { "items": [ { "abdominal_pain": "never", "assistance": "without_assistance", "duration": "0", "frequency": "1_2_times_per_1_2_days", "incomplete_evacuation": "never", "painful_evacuation": "never", "time_per_attempt": "less_than_5", "unsuccessful_attempts": "never" }, { "abdominal_pain": "never", "assistance": "without_assistance", "duration": "0", "frequency": "1_2_times_per_1_2_days", "incomplete_evacuation": "never", "painful_evacuation": "never", "time_per_attempt": "less_than_5", "unsuccessful_attempts": "never" } ] } ``` Human paywall (two-item fixture): https://api.magentlab.com/paywall/bulk/wexner-constipation Example 200: ```json { "count": 2, "path": "/api/calc/wexner_constipation", "items": [ { "components": [ { "value": "1_2_times_per_1_2_days", "factor": "frequency", "points": 0, "present": false }, { "value": "never", "factor": "painful_evacuation", "points": 0, "present": false }, { "value": "never", "factor": "incomplete_evacuation", "points": 0, "present": false }, { "value": "never", "factor": "abdominal_pain", "points": 0, "present": false }, { "value": "less_than_5", "factor": "time_per_attempt", "points": 0, "present": false }, { "value": "without_assistance", "factor": "assistance", "points": 0, "present": false }, { "value": "never", "factor": "unsuccessful_attempts", "points": 0, "present": false }, { "value": "0", "factor": "duration", "points": 0, "present": false } ], "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.", "citation": { "authors": "Agachan F, Chen T, Pfeifer J, Reissman P, Wexner SD", "doi": "10.1007/BF02056950", "id": "agachan-1996", "pmid": "8646957", "source": "Dis Colon Rectum. 1996;39(6):681-685", "title": "A constipation scoring system to simplify evaluation and management of constipated patients" }, "formula": "wexner_constipation", "formula_expression": "wexner_constipation = frequency + painful_evacuation + incomplete_evacuation + abdominal_pain + time_per_attempt + assistance + unsuccessful_attempts + duration; Agachan 1996 eight-item constipation scoring system; frequency, painful_evacuation, incomplete_evacuation, abdominal_pain, time_per_attempt, unsuccessful_attempts, and duration each 0-4; assistance 0-2; max 30; constipation iff score > 15", "max_score": 30, "score": 0, "cutoff": 15, "constipation": false }, { "components": [ { "value": "1_2_times_per_1_2_days", "factor": "frequency", "points": 0, "present": false }, { "value": "never", "factor": "painful_evacuation", "points": 0, "present": false }, { "value": "never", "factor": "incomplete_evacuation", "points": 0, "present": false }, { "value": "never", "factor": "abdominal_pain", "points": 0, "present": false }, { "value": "less_than_5", "factor": "time_per_attempt", "points": 0, "present": false }, { "value": "without_assistance", "factor": "assistance", "points": 0, "present": false }, { "value": "never", "factor": "unsuccessful_attempts", "points": 0, "present": false }, { "value": "0", "factor": "duration", "points": 0, "present": false } ], "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.", "citation": { "authors": "Agachan F, Chen T, Pfeifer J, Reissman P, Wexner SD", "doi": "10.1007/BF02056950", "id": "agachan-1996", "pmid": "8646957", "source": "Dis Colon Rectum. 1996;39(6):681-685", "title": "A constipation scoring system to simplify evaluation and management of constipated patients" }, "formula": "wexner_constipation", "formula_expression": "wexner_constipation = frequency + painful_evacuation + incomplete_evacuation + abdominal_pain + time_per_attempt + assistance + unsuccessful_attempts + duration; Agachan 1996 eight-item constipation scoring system; frequency, painful_evacuation, incomplete_evacuation, abdominal_pain, time_per_attempt, unsuccessful_attempts, and duration each 0-4; assistance 0-2; max 30; constipation iff score > 15", "max_score": 30, "score": 0, "cutoff": 15, "constipation": false } ] } ``` ## Response fields - `formula` (string): wexner_constipation - `formula_expression` (string): Exact expression used - `score` (integer): Agachan 1996 constipation scoring system points 0-30 - `max_score` (integer): 30 - `cutoff` (integer): 15. Agachan 1996 derivation patients all scored more than 15. constipation is true iff score > 15. Score 15 is not constipation by that cut. - `constipation` (boolean): true iff score > 15 (Agachan 1996 derivation cohort). Not Rome. Not an ODS-only extra band. Not a diagnosis. - `components` (array): Per-item Agachan 1996 points - `citation` (object): Agachan et al. Dis Colon Rectum 1996 citation - `disclaimer` (string): Not-a-device notice ## Example JSON Frozen fixture. Not a live lookup. ```json { "components": [ { "value": "1_2_times_per_1_2_days", "factor": "frequency", "points": 0, "present": false }, { "value": "never", "factor": "painful_evacuation", "points": 0, "present": false }, { "value": "never", "factor": "incomplete_evacuation", "points": 0, "present": false }, { "value": "never", "factor": "abdominal_pain", "points": 0, "present": false }, { "value": "less_than_5", "factor": "time_per_attempt", "points": 0, "present": false }, { "value": "without_assistance", "factor": "assistance", "points": 0, "present": false }, { "value": "never", "factor": "unsuccessful_attempts", "points": 0, "present": false }, { "value": "0", "factor": "duration", "points": 0, "present": false } ], "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.", "citation": { "authors": "Agachan F, Chen T, Pfeifer J, Reissman P, Wexner SD", "doi": "10.1007/BF02056950", "id": "agachan-1996", "pmid": "8646957", "source": "Dis Colon Rectum. 1996;39(6):681-685", "title": "A constipation scoring system to simplify evaluation and management of constipated patients" }, "formula": "wexner_constipation", "formula_expression": "wexner_constipation = frequency + painful_evacuation + incomplete_evacuation + abdominal_pain + time_per_attempt + assistance + unsuccessful_attempts + duration; Agachan 1996 eight-item constipation scoring system; frequency, painful_evacuation, incomplete_evacuation, abdominal_pain, time_per_attempt, unsuccessful_attempts, and duration each 0-4; assistance 0-2; max 30; constipation iff score > 15", "max_score": 30, "score": 0, "cutoff": 15, "constipation": false } ``` ## Errors - HTTP 400 `invalid_wexner_constipation`: Constipation score inputs must match Agachan 1996 frequency, evacuation, pain, time, assistance, failures, and duration bands from that paper. Returned before settlement; you are not charged. - HTTP 400 `invalid_items`: POST body must be a JSON object with only an items array Returned before settlement; you are not charged. - HTTP 400 `invalid_item_count`: items must be an array of 1 to 25 objects Returned before settlement; you are not charged. - HTTP 400 `invalid_item`: each items entry must be a JSON object Returned before settlement; you are not charged. Shared HTTP 402 and 503: https://magentlab.com/docs/payments ## Related tools - [Rome IV FC](https://magentlab.com/docs/rome-iv-fc) — Apply the Mearin 2016 Rome IV C2 functional constipation criteria and return symptom_count (0-6) and whether the published C2 box holds (rome_iv_fc). - [Rome IV OIC](https://magentlab.com/docs/rome-iv-oic) — Apply the Mearin 2016 Rome IV C6 opioid-induced constipation criteria and return symptom_count (0-6) and whether the published C6 box holds (rome_iv_oic). - [Kruis](https://magentlab.com/docs/kruis) — Sum the Kruis 1984 signed weights (history items plus physical and laboratory flags) and return whether the published IBS cutoff of 44 is met. ## Payment Unpaid requests return HTTP 402 even if query parameters or POST items are missing or invalid, so CDP and agents can index the path. After a PAYMENT-SIGNATURE, invalid params return HTTP 400 JSON before settlement. magent does not charge. Fix the params, then request a new 402 quote for that complete URL. Catalog misses (empty matches, found=false) are valid paid 200s. - GET the tool with Accept: application/json (do not send Accept: text/html unless you want the human paywall). - HTTP 402 means you have not paid. Decode the base64 PAYMENT-REQUIRED header. HTTP 503 is not a new quote. - Sign accepts[0] (exact, EIP-3009) with validBefore = now + maxTimeoutSeconds (600 seconds), or accepts[1] (batch-settlement deposit/voucher) on product GET. Ping and POST {items} stay exact. Magent retries transient facilitator 429/5xx before answering. - Retry the same URL with PAYMENT-SIGNATURE (base64 JSON of accepted and payload). Magent attaches canonical extensions.bazaar on CDP verify/settle; echoing 402 bazaar is optional. - Success is HTTP 200 JSON plus PAYMENT-RESPONSE. exact settles before the tool. batch-settlement verifies (and deposit-settles) before the tool and commits the charge after HTTP 2xx. HTTP 503: retry the same PAYMENT-SIGNATURE. Mint a new exact nonce only after a new HTTP 402. - offered `exact` on eip155:8453: Fixed-price USDC on Base. The buyer authorizes the advertised amount (EIP-3009). magent settles before the tool runs (paymentFlow upfront). extra.assetTransferMethod=eip3009 extra.paymentFlow=upfront. - offered `batch-settlement` on eip155:8453: Payment-channel vouchers claimed later in batches. Exact stays accepts[0]. Same-path POST {items} is still exact. extra.assetTransferMethod=eip3009 extra.paymentFlow=authorization. - not offered `upto`: Not offered. Usage-based: buyer authorizes a ceiling, seller settles the actual amount after work. Reserved for a future metered tool. Not for current calculators or code search. Same-path POST {items} is still scheme exact: one EIP-3009 authorization for GET unit plus $0.002 per extra item. That is not x402 batch-settlement (payment channels / vouchers). Shared HTTP 402 and 503 table: https://magentlab.com/docs/payments Stdio MCP (one process per host): https://magentlab.com/docs/mcp ## Guarantees - HTTP 402 is unpaid, including a missing query. After PAYMENT-SIGNATURE, invalid parameters return HTTP 400 before settlement. You are not charged. HTTP 402 never includes the tool JSON. - exact: settlement finishes before the tool (paymentFlow upfront). batch-settlement: verify/deposit before the tool; chargedCumulativeAmount commits after HTTP 2xx. Uncertain or failed settlement fails closed (HTTP 503). Retry the same PAYMENT-SIGNATURE. - HTTP 402 is unpaid only. Do not sign a second authorization because of a 503. - Execution is timeout-bounded and concurrency-capped. - Calculator inputs are stored encrypted for allowlisted operators (Magent Console). They are not in public logs, SSH lookups, catalog, or rollups. Request logs store path without query.