Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Constipation Differential Diagnoses

  • Author: Marc D Basson, MD, PhD, MBA, FACS; Chief Editor: BS Anand, MD  more...
 
Updated: Sep 29, 2015
 
 

Diagnostic Considerations

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
  • Hyperparathyroidism
  • Hypothyroidism
  • Uremia
  • Lead poisoning
  • Neuropathy
  • Parkinson disease
  • Multiple sclerosis
  • Spinal cord injuries
  • Scleroderma
  • Lupus
  • Amyloidosis

Differential Diagnoses

 
 
Contributor Information and Disclosures
Author

Marc D Basson, MD, PhD, MBA, FACS Associate Dean for Medicine, Professor of Surgery and Basic Science, University of North Dakota School of Medicine and Health Sciences

Marc D Basson, MD, PhD, MBA, FACS is a member of the following medical societies: Alpha Omega Alpha, American College of Surgeons, American Gastroenterological Association, Phi Beta Kappa, Sigma Xi

Disclosure: Nothing to disclose.

Chief Editor

BS Anand, MD Professor, Department of Internal Medicine, Division of Gastroenterology, Baylor College of Medicine

BS Anand, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Acknowledgements

BS Anand, MD Professor, Department of Internal Medicine, Division of Gastroenterology, Baylor College of Medicine

BS Anand, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American Gastroenterological Association, and American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Barry E Brenner, MD, PhD, FACEP Professor of Emergency Medicine, Professor of Internal Medicine, Program Director, Emergency Medicine, University Hospitals, Case Medical Center

Barry E Brenner, MD, PhD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Chest Physicians, American College of Emergency Physicians, American College of Physicians, American Heart Association, American Thoracic Society, Arkansas Medical Society, New York Academy of Medicine, New York Academy ofSciences, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

William K Chiang, MD Associate Professor, Department of Emergency Medicine, New York University School of Medicine; Chief of Service, Department of Emergency Medicine, Bellevue Hospital Center

William K Chiang, MD is a member of the following medical societies: American Academy of Clinical Toxicology, American College of Medical Toxicology, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Ronnie Fass, MD, FACP, FACG Chief of Gastroenterology, Head of Neuroenteric Clinical Research Group, Southern Arizona Veterans Affairs Health Care System; Professor of Medicine, Division of Gastroenterology, University of Arizona School of Medicine

Ronnie Fass, MD, FACP, FACG is a member of the following medical societies: American College of Gastroenterology, American College of Physicians-American Society of Internal Medicine, American Gastroenterological Association, American Motility Society, American Society for Gastrointestinal Endoscopy, and Israel Medical Association

Disclosure: Takeda Pharmaceuticals Grant/research funds Conducting research; Takeda Pharmaceuticals Consulting fee Consulting; Takeda Pharmaceuticals Honoraria Speaking and teaching; Vecta Consulting fee Consulting; XenoPort Consulting fee Consulting; Eisai Honoraria Speaking and teaching; Wyeth Pharmaceuticals Conducting research; AstraZeneca Grant/research funds Conducting research; Eisai Consulting fee Consulting

Eugene Hardin, MD, FAAEM, FACEP Former Chair and Associate Professor, Department of Emergency Medicine, Charles Drew University of Medicine and Science; Former Chair, Department of Emergency Medicine, Martin Luther King Jr/Drew Medical Center

Disclosure: Nothing to disclose.

Dave A Holson, MD, MBBS, MPH Assistant Professor of Emergency Medicine, Mount Sinai School of Medicine; Director, Department of Emergency Medicine, Queens Hospital Center

Dave A Holson, MD, MBBS, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, National Medical Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

References
  1. 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.

  2. Longstreth GF, Thompson WG, Chey WD, Houghton LA, Mearin F, Spiller RC. Functional bowel disorders. Gastroenterology. 2006 Apr. 130(5):1480-91. [Medline].

  3. Uher R, Farmer A, Henigsberg N, et al. Adverse reactions to antidepressants. Br J Psychiatry. 2009 Sep. 195(3):202-10. [Medline].

  4. 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].

  5. 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].

  6. 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].

  7. Sonnenberg A, Koch TR. Epidemiology of constipation in the United States. Dis Colon Rectum. 1989 Jan. 32(1):1-8. [Medline].

  8. Bouras EP, Tangalos EG. Chronic constipation in the elderly. Gastroenterol Clin North Am. 2009 Sep. 38(3):463-80. [Medline].

  9. 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].

  10. 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].

  11. 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].

  12. 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].

  13. 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.

  14. 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.

  15. 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].

  16. 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.

  17. 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].

  18. Lembo AJ, Schneier HA, Shiff SJ, et al. Two randomized trials of linaclotide for chronic constipation. N Engl J Med. 2011 Aug 11. 365(6):527-36. [Medline]. [Full Text].

  19. 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].

  20. Brown SR. Tegaserod for chronic constipation. J Fam Pract. 2005 Dec. 54(12):1060, 1063. [Medline].

  21. Di Palma JA. Expert commentary--new developments in the treatment of constipation. MedGenMed. 2005 Jan 1. 7(1):17. [Medline].

  22. 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].

  23. Zelnorm (tegaserod) emergency treatment IND program. Novartis Pharmaceuticals Corp. July 16, 2014.

  24. 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.

  25. 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].

  26. 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].

  27. 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].

  28. 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].

  29. 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].

  30. 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].

  31. 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].

  32. Biggs WS, Dery WH. Evaluation and treatment of constipation in infants and children. Am Fam Physician. 2006 Feb 1. 73(3):469-77. [Medline].

  33. 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].

  34. 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.

  35. Anderson P. FDA okays naloxegol (Movantik) in opioid-induced constipation. Medscape Medical News. September 16, 2014. [Full Text].

  36. 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].

  37. 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].

  38. Relistor (methylnaltrexone bromide) subcutaneous injection [package insert]. Tarrytown, NY: Progenics Pharmaceuticals, Inc. September, 2014. Available at [Full Text].

  39. 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].

  40. 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.

Previous
Next
 
Large amount of stool throughout colon.
Large stool mass in hepatic flexure of colon.
Colon distention secondary to fecal impaction.
Pseudo-obstruction secondary to fecal impaction.
Distended transverse colon.
Distended rectum.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.