Constipation Differential Diagnoses
- Author: Marc D Basson, MD, PhD, MBA, FACS; Chief Editor: BS Anand, MD more...
It is important to be vigilant for colorectal cancer. Anal fissure should be considered in a constipated child. Colonic ileus secondary to sepsis or an intra-abdominal catastrophe may be misdiagnosed as constipation; large bowel obstruction may also be misdiagnosed as constipation.
In addition to the conditions listed in the differential diagnosis, the following problems should be considered:
- Psychological causes
- Diabetes mellitus
- Lead poisoning
- Parkinson disease
- Multiple sclerosis
- Spinal cord injuries
Pharmaceutical Business Review. Ironwood Pharma, Forest Labs Present Linaclotide Phase 3 Trial Results. pharmaceutical-business-review.com. Available at http://clinicaltrials.pharmaceutical-business-review.com/news/ironwood_pharma_forest_labs_present_linaclotide_phase_3_trial_results_100504/. Accessed: May 4, 2010.
Longstreth GF, Thompson WG, Chey WD, Houghton LA, Mearin F, Spiller RC. Functional bowel disorders. Gastroenterology. 2006 Apr. 130(5):1480-91. [Medline].
Uher R, Farmer A, Henigsberg N, et al. Adverse reactions to antidepressants. Br J Psychiatry. 2009 Sep. 195(3):202-10. [Medline].
Staats PS, Markowitz J, Schein J. Incidence of constipation associated with long-acting opioid therapy: a comparative study. South Med J. 2004 Feb. 97(2):129-34. [Medline].
Martin BC, Barghout V, Cerulli A. Direct medical costs of constipation in the United States. Manag Care Interface. 2006 Dec. 19(12):43-9. [Medline].
Peppas G, Alexiou VG, Mourtzoukou E, et al. Epidemiology of constipation in Europe and Oceania: a systematic review. BMC Gastroenterol. 2008 Feb 12. 8:5. [Medline].
Sonnenberg A, Koch TR. Epidemiology of constipation in the United States. Dis Colon Rectum. 1989 Jan. 32(1):1-8. [Medline].
Bouras EP, Tangalos EG. Chronic constipation in the elderly. Gastroenterol Clin North Am. 2009 Sep. 38(3):463-80. [Medline].
Amselem C, Puigdollers A, Azpiroz F, et al. Constipation: a potential cause of pelvic floor damage?. Neurogastroenterol Motil. 2010 Feb. 22(2):150-3, e48. [Medline].
Noguera A, Centeno C, Librada S, Nabal M. Screening for constipation in palliative care patients. J Palliat Med. 2009 Oct. 12(10):915-20. [Medline].
Taghavi SA, Shabani S, Mehramiri A, et al. Colchicine is effective for short-term treatment of slow transit constipation: a double-blind placebo-controlled clinical trial. Int J Colorectal Dis. 2010 Mar. 25(3):389-94. [Medline].
Gladman MA, Knowles CH. Novel concepts in the diagnosis, pathophysiology and management of idiopathic megabowel. Colorectal Dis. 2008 Jul. 10(6):531-8; discussion 538-40. [Medline].
Brooks M. FDA Issues Safety Warning for Sodium Phosphate for Constipation. Medscape [serial online]. Available at http://www.medscape.com/viewarticle/818859. Accessed: January 13, 2014.
FDA Safety Announcement. FDA warns of possible harm from exceeding recommended dose of over-the-counter sodium phosphate products to treat constipation. US Food and Drug Administration. Available at http://www.fda.gov/Drugs/DrugSafety/ucm380757.htm. Accessed: January 13, 2014.
Ford AC, Suares NC. Effect of laxatives and pharmacological therapies in chronic idiopathic constipation: systematic review and meta-analysis. Gut. 2011 Feb. 60(2):209-18. [Medline].
Melville NA. Long-Term Efficacy With Lubiprostone in Opioid Constipation. Medscape [serial online]. Available at http://www.medscape.com/viewarticle/810646. Accessed: September 16, 2013.
Lembo AJ, Kurtz CB, Macdougall JE, et al. Efficacy of linaclotide for patients with chronic constipation. Gastroenterology. 2010 Mar. 138(3):886-95.e1. [Medline].
Rao S, Lembo AJ, Shiff SJ, et al. A 12-week, randomized, controlled trial with a 4-week randomized withdrawal period to evaluate the efficacy and safety of linaclotide in irritable bowel syndrome with constipation. Am J Gastroenterol. 2012 Nov. 107(11):1714-24; quiz p.1725. [Medline].
Brown SR. Tegaserod for chronic constipation. J Fam Pract. 2005 Dec. 54(12):1060, 1063. [Medline].
Di Palma JA. Expert commentary--new developments in the treatment of constipation. MedGenMed. 2005 Jan 1. 7(1):17. [Medline].
Layer P, Keller J, Loeffler H, et al. Tegaserod in the treatment of irritable bowel syndrome (IBS) with constipation as the prime symptom. Ther Clin Risk Manag. 2007 Mar. 3(1):107-18. [Medline].
Zelnorm (tegaserod) emergency treatment IND program. Novartis Pharmaceuticals Corp. July 16, 2014.
Johanson JF. Review of the treatment options for chronic constipation. MedGenMed [serial online]. May 2, 2007;9 (2):25-40. Available at http://www.medscape.com/viewarticle/550956. Accessed: April 26, 2010.
Hsiao KC, Jao SW, Wu CC, et al. Hand-assisted laparoscopic total colectomy for slow transit constipation. Int J Colorectal Dis. 2008 Apr. 23(4):419-24. [Medline].
Tomita R, Fujisak S. Minilaparotomy with a gasless laparoscopic-assisted procedure by abdominal wall lifting for ileorectal anastomosis in patients with slow transit constipation. Hepatogastroenterology. 2009 Jul-Aug. 56(93):1022-7. [Medline].
Frascio M, Stabilini C, Ricci B, et al. Stapled transanal rectal resection for outlet obstruction syndrome: results and follow-up. World J Surg. 2008 Jun. 32(6):1110-5. [Medline].
Bona S, Battafarano F, Fumagalli Romario U, et al. Stapled anopexy: postoperative course and functional outcome in 400 patients. Dis Colon Rectum. 2008 Jun. 51(6):950-5. [Medline].
van den Esschert JW, van Geloven AA, Vermulst N, Groenedijk AG, de Wit LT, Gerhards MF. Laparoscopic ventral rectopexy for obstructed defecation syndrome. Surg Endosc. 2008 Dec. 22(12):2728-32. [Medline].
Mowatt G, Glazener C, Jarrett M. Sacral nerve stimulation for fecal incontinence and constipation in adults: a short version Cochrane review. Neurourol Urodyn. 2008. 27(3):155-61. [Medline].
Holzer B, Rosen HR, Novi G, et al. Sacral nerve stimulation in patients with severe constipation. Dis Colon Rectum. 2008 May. 51(5):524-29; discussion 529-30. [Medline].
Biggs WS, Dery WH. Evaluation and treatment of constipation in infants and children. Am Fam Physician. 2006 Feb 1. 73(3):469-77. [Medline].
Cryer B, Katz S, Vallejo R, Popescu A, Ueno R. A randomized study of lubiprostone for opioid-induced constipation in patients with chronic noncancer pain. Pain Med. 2014 Nov. 15(11):1825-34. [Medline].
Jeffrey S. FDA Approves Amitiza for Opioid-Induced Constipation. Medscape Medical News. April 23, 2013. Available at http://www.medscape.com/viewarticle/802953. Accessed: April 30, 2013.
Anderson P. FDA okays naloxegol (Movantik) in opioid-induced constipation. Medscape Medical News. September 16, 2014. [Full Text].
Chey WD, Webster L, Sostek M, Lappalainen J, Barker PN, Tack J. Naloxegol for opioid-induced constipation in patients with noncancer pain. N Engl J Med. 2014 Jun 19. 370(25):2387-96. [Medline].
Webster L, Chey WD, Tack J, Lappalainen J, Diva U, Sostek M. Randomised clinical trial: the long-term safety and tolerability of naloxegol in patients with pain and opioid-induced constipation. Aliment Pharmacol Ther. 2014 Oct. 40(7):771-9. [Medline].
Relistor (methylnaltrexone bromide) subcutaneous injection [package insert]. Tarrytown, NY: Progenics Pharmaceuticals, Inc. September, 2014. Available at [Full Text].
Camilleri M, Beyens G, Kerstens R, Robinson P, Vandeplassche L. Safety assessment of prucalopride in elderly patients with constipation: a double-blind, placebo-controlled study. Neurogastroenterol Motil. 2009 Dec. 21(12):1256-e117. [Medline].
US Food and Drug Administration. FDA approves Movantik for opioid-induced constipation. 2014 Sept 16. Available at http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm414620.htm. Accessed: September 16, 2014.