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===Differentiating Diseases that Cause Constipation===
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! rowspan="2" |Diseases
! colspan="7" |History and Symptoms
! colspan="4" |Physical Examination
! colspan="5" |Laboratory Findings
! rowspan="2" |Other Findings
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
!Weight loss
!Abdominal pain
!Anal pain
!Dysphagia
!Polyphagia, Polyuria, Polydipsia
!Dry skin
!Tremor
!Abnormal gait
!Protruding mass
!Sphincter manometry
!Deep tendon reflex
!Mg
!K
!Ca
!FBS
!TSH
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Malignancy]]'''
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
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| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Autonomic neuropathy|Diabetic autonomic neuropathy]]'''
| style="background: #F5F5F5; padding: 5px;" |'''↑'''
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| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Irritable bowel syndrome|Irritable bowel syndrome (IBS)]]'''
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |↓
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| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Rectocele]]'''
| style="background: #F5F5F5; padding: 5px;" |
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| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
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| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Anal fissure]]'''
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
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|'''[[Anismus]]'''
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|'''[[Systemic sclerosis]]'''
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|'''[[Hypothyroidism]]'''
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|'''[[Parkinson's disease]]'''
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|'''[[Multiple sclerosis]]'''
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|'''[[Hypomagnesemia]]'''
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|'''[[Hypocalcemia]]'''
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|'''[[Depression]]'''
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|'''[[Pregnancy]]'''
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Revision as of 21:12, 19 December 2017

Constipation Microchapters

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Patient Information

Overview

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Differentiating Constipation from other Diseases

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Ultrasound

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Primary Prevention

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Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Constipation On the Web

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Images

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MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Constipation

CDC on Constipation

Constipation in the news

Blogs on Constipation

Directions to Hospitals Treating Constipation

Risk calculators and risk factors for Constipation

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Eiman Ghaffarpasand, M.D. [2]

Overview

Diseases that cause constipation should differentiate from each others, such as malignancy, diabetic autonomic neuropathy, irritable bowel syndrome, rectocele, fissure, anismus, systemic sclerosis, hypothyroidism, Parkinson's disease, multiple sclerosis, hypomagnesemia, hypocalcemia, and depression.

Differentiating Constipation from Other Diseases

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
•Weight loss>10 lb
•FHx of CRC
•Acute onset in elderly
•Hematoschezia
•Iron deficiency anemia
•Positive OB
 
 
 
 
 
 
 
 
 
 
 
•Analgesic
•Anticholinergic
••Antihistamines
••Antispasmodics
••Antidepressants
••Antipsychotics
•Cation-Containing agent
••Iron supplements
••Aluminum (antacids, sucralfate)
••Barium
•Neuron targeting agents
••Opiates
••Antihypertensive
••Ganglion blockers
••Calcium channel blockers
••5HT3 antagonists
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Alarm signs
 
 
 
 
 
 
 
Drugs
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Constipation
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Abdominal pain
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
YES
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
NO
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Irritable bowel syndrome
Malignancy
Diabetic autonomic neuropathy
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Hypothyroidism
Hypomagnesemia
Hypocalcemia
Systemic sclerosis
Multiple sclerosis
Parkinson disease
Depression
Fissure
Anismus
Rectocele
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Weight loss
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Anal pain
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
YES
 
 
 
NO
 
 
 
 
 
 
YES
 
 
 
 
 
 
 
 
 
 
 
 
 
 
NO
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Irritable bowel syndrome
Diabetic autonomic neuropathy
 
 
 
 
 
 
Fissure
Anismus
Rectocele
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Hypothyroidism
Hypomagnesemia
Hypocalcemia
Systemic sclerosis
Multiple sclerosis
Parkinson disease
Depression
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Polyuria
Polydypsia
Polyphagia
 
 
 
 
 
 
Mass protrusion
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Dry skin
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
YES
 
NO
 
YES
 
 
 
NO
 
 
 
 
 
YES
 
 
 
 
 
 
 
 
 
 
NO
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Fissure
Anismus
 
 
 
 
 
Hypothyroidism
Systemic sclerosis
 
 
 
 
 
 
 
 
 
 
Hypomagnesemia
Hypocalcemia
Multiple sclerosis
Parkinson's disease
Depression
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Rectal bleeding
 
 
 
 
 
Dysphagia
 
 
 
 
 
 
 
 
 
 
Neurologic symptoms
(tremor, abnormal gait)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
YES
 
NO
 
YES
 
NO
 
 
 
YES
 
 
 
 
 
 
 
NO
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Multiple sclerosis
Parkinson disease
 
 
 
 
 
 
 
Hypomagnesemia
Hypocalcemia
Depression
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Basal ganglia atrophy in MRI
 
 
 
 
 
 
 
Electrolyte disturbance
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
YES
 
NO
 
YES
 
YES
 
NO
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Malignancy
 
Diabetic autonomic neuropathy
 
Irritable bowel syndrome
 
Rectocele
 
Fissure
 
Anismus
 
Systemic sclerosis
 
Hypothyroidism
 
Parkinson's disease
 
Multiple sclerosis
 
Hypomagnesemia
 
Hypocalcemia
 
Depression
 

Differentiating Diseases that Cause Constipation

Diseases History and Symptoms Physical Examination Laboratory Findings Other Findings
Weight loss Abdominal pain Anal pain Dysphagia Polyphagia, Polyuria, Polydipsia Dry skin Tremor Abnormal gait Protruding mass Sphincter manometry Deep tendon reflex Mg K Ca FBS TSH
Malignancy +
Diabetic autonomic neuropathy ↑ -
Irritable bowel syndrome (IBS) ↓
Rectocele
Anal fissure
Anismus
Systemic sclerosis
Hypothyroidism
Parkinson's disease
Multiple sclerosis
Hypomagnesemia
Hypocalcemia
Depression
Pregnancy


References

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