Constipation Differential Diagnoses

  • Author: Marc D Basson, MD, PhD, MBA, FACS; Chief Editor: Julian Katz, MD   more...
 
Updated: Sep 28, 2011
 
 

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

Proceed to Workup
 
 
Contributor Information and Disclosures
Author

Marc D Basson, MD, PhD, MBA, FACS  Professor, Chair, Department of Surgery, Assistant Dean for Faculty Development in Research, Michigan State University College of Human Medicine

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, and Sigma Xi

Disclosure: Nothing to disclose.

Chief Editor

Julian Katz, MD  Clinical Professor of Medicine, Drexel University College of Medicine

Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law, Medicine & Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility

Disclosure: Nothing to disclose.

Additional Contributors

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

  2. Uher R, Farmer A, Henigsberg N, Rietschel M, Mors O, Maier W, et al. Adverse reactions to antidepressants. Br J Psychiatry. Sep 2009;195(3):202-10. [Medline].

  3. Staats PS, Markowitz J, Schein J. Incidence of constipation associated with long-acting opioid therapy: a comparative study. South Med J. Feb 2004;97(2):129-34. [Medline].

  4. Martin BC, Barghout V, Cerulli A. Direct medical costs of constipation in the United States. Manag Care Interface. Dec 2006;19(12):43-9. [Medline].

  5. Peppas G, Alexiou VG, Mourtzoukou E, et al. Epidemiology of constipation in Europe and Oceania: a systematic review. BMC Gastroenterol. Feb 12 2008;8:5. [Medline].

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

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

  8. Noguera A, Centeno C, Librada S, Nabal M. Screening for Constipation in Palliative Care Patients. J Palliat Med. Sep 11 2009;[Medline].

  9. Taghavi SA, Shabani S, Mehramiri A, Eshraghian A, Kazemi SM, Moeini M, et al. Colchicine is effective for short-term treatment of slow transit constipation: a double-blind placebo-controlled clinical trial. Int J Colorectal Dis. Aug 25 2009;[Medline].

  10. Amselem C, Puigdollers A, Azpiroz F, Sala C, Videla S, Fernández-Fraga X, et al. Constipation: a potential cause of pelvic floor damage?. Neurogastroenterol Motil. Sep 17 2009;[Medline].

  11. Gladman MA, Knowles CH. Novel concepts in the diagnosis, pathophysiology and management of idiopathic megabowel. Colorectal Dis. Jul 2008;10(6):531-8; discussion 538-40. [Medline].

  12. Ford AC, Suares NC. Effect of laxatives and pharmacological therapies in chronic idiopathic constipation: systematic review and meta-analysis. Gut. Feb 2011;60(2):209-18. [Medline].

  13. 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.

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

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

  16. 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. Mar 2007;3(1):107-18. [Medline].

  17. 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.

  18. Hsiao KC, Jao SW, Wu CC, et al. Hand-assisted laparoscopic total colectomy for slow transit constipation. Int J Colorectal Dis. Apr 2008;23(4):419-24. [Medline].

  19. 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. Jul-Aug 2009;56(93):1022-7. [Medline].

  20. Frascio M, Stabilini C, Ricci B, et al. Stapled transanal rectal resection for outlet obstruction syndrome: results and follow-up. World J Surg. Jun 2008;32(6):1110-5. [Medline].

  21. Bona S, Battafarano F, Fumagalli Romario U, et al. Stapled anopexy: postoperative course and functional outcome in 400 patients. Dis Colon Rectum. Jun 2008;51(6):950-5. [Medline].

  22. van den Esschert JW, van Geloven AA, Vermulst N, et al. Laparoscopic ventral rectopexy for obstructed defecation syndrome. Surg Endosc. Mar 5 2008;[Medline].

  23. 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].

  24. Holzer B, Rosen HR, Novi G, et al. Sacral nerve stimulation in patients with severe constipation. Dis Colon Rectum. May 2008;51(5):524-29; discussion 529-30. [Medline].

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

  26. 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. Sep 9 2009;[Medline].

 
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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.
 
 
 
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