Constipation physical examination: Difference between revisions

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__NOTOC__
__NOTOC__
{{Constipation}}
{{Constipation}}
{{CMG}} {{AE}}{{EG}}
{{CMG}}; {{AE}} {{EG}}


==Overview==
==Overview==
Physical examination of patients with constipation is usually remarkable for [[anal fissure]] or palpable lumpy [[mass]] in [[abdomen]], particularly in left quadrant. The presence of [[thrombosed]] [[Hemorrhoid|external hemorrhoids]], [[skin tags]], [[rectal prolapse]], [[anal fissure]], [[Anal wart|anal warts]], [[excoriation]] or evidence of [[pruritus ani]] due to fecal soiling on [[physical examination]] are suggestive of constipation. Patients with chronic constipation usually appear to be discomfort while sit because of [[anal pain]].
Physical examination of patients with constipation is usually remarkable for [[anal fissure]] or palpable lumpy [[mass]] in [[abdomen]] (particularly in left quadrant). The presence of [[thrombosed]] [[Hemorrhoid|external hemorrhoids]], [[skin tags]], [[rectal prolapse]], [[anal fissure]], [[Anal wart|anal warts]], [[excoriation]] or evidence of [[pruritus ani]] due to fecal soiling on [[physical examination]] are suggestive of constipation. Patients with chronic constipation usually appear to be discomfort while sitting due to [[anal pain]].


== Physical Examination ==
== Physical Examination ==
*Physical examination of patients with constipation is usually remarkable for [[anal fissure]] or palpable lumpy [[mass]] in [[abdomen]], particularly in left quadrant.
*Physical examination of patients with constipation is usually remarkable for [[anal fissure]] or palpable lumpy [[mass]] in [[abdomen]] (particularly in left quadrant).
*The presence of [[thrombosed]] [[Hemorrhoid|external hemorrhoids]], [[skin tags]], [[rectal prolapse]], [[anal fissure]], [[Anal wart|anal warts]], [[excoriation]] or evidence of [[pruritus ani]] due to fecal soiling on [[physical examination]] are suggestive of constipation.<ref name="pmid21382584">{{cite journal| author=Rao SS, Meduri K| title=What is necessary to diagnose constipation? | journal=Best Pract Res Clin Gastroenterol | year= 2011 | volume= 25 | issue= 1 | pages= 127-40 | pmid=21382584 | doi=10.1016/j.bpg.2010.11.001 | pmc=3063397 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21382584  }}</ref>
*The presence of [[thrombosed]] [[Hemorrhoid|external hemorrhoids]], [[skin tags]], [[rectal prolapse]], [[anal fissure]], [[Anal wart|anal warts]], [[excoriation]] or evidence of [[pruritus ani]] due to fecal soiling on [[physical examination]] are suggestive of constipation.<ref name="pmid21382584">{{cite journal| author=Rao SS, Meduri K| title=What is necessary to diagnose constipation? | journal=Best Pract Res Clin Gastroenterol | year= 2011 | volume= 25 | issue= 1 | pages= 127-40 | pmid=21382584 | doi=10.1016/j.bpg.2010.11.001 | pmc=3063397 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21382584  }}</ref>
===Appearance of the Patient===
===Appearance of the Patient===
*Patients with chronic constipation usually appear to be discomfort while sit because of [[anal pain]].
*Patients with chronic constipation usually appear to be discomfort while sitting due to [[anal pain]]
===Skin===
===Skin===
*[[Dry skin]] may be seen in systemic sclerosis
*[[Dry skin]] may be seen in [[systemic sclerosis]]


=== HEENT ===
=== HEENT ===
Line 23: Line 23:
*A palpable [[abdominal mass]] in the left lower abdominal quadrant
*A palpable [[abdominal mass]] in the left lower abdominal quadrant
===Neuromuscular===
===Neuromuscular===
*Patient is maybe not oriented to persons, place, and time
*[[Altered mental status]]
*[[Altered mental status]]
*[[Clonus]] may be present
*[[Clonus]] may be present
Line 32: Line 31:
*Unilateral/bilateral [[tremor]] (pill-rolling)
*Unilateral/bilateral [[tremor]] (pill-rolling)


=== Digital rectal examination (DRE)<ref name="pmid20656061">{{cite journal |vauthors=Tantiphlachiva K, Rao P, Attaluri A, Rao SS |title=Digital rectal examination is a useful tool for identifying patients with dyssynergia |journal=Clin. Gastroenterol. Hepatol. |volume=8 |issue=11 |pages=955–60 |year=2010 |pmid=20656061 |doi=10.1016/j.cgh.2010.06.031 |url=}}</ref> ===
=== Digital rectal examination (DRE)===
{| class="wikitable"
Method and findings of digital rectal examination include:<ref name="pmid20656061">{{cite journal |vauthors=Tantiphlachiva K, Rao P, Attaluri A, Rao SS |title=Digital rectal examination is a useful tool for identifying patients with dyssynergia |journal=Clin. Gastroenterol. Hepatol. |volume=8 |issue=11 |pages=955–60 |year=2010 |pmid=20656061 |doi=10.1016/j.cgh.2010.06.031 |url=}}</ref>
! colspan="2" |DRE steps respectively
{|
!Method
! colspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" + |DRE steps respectively
!Findings
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Method
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Findings
|-
|-
| colspan="2" |'''''[[Inspection (medicine)|Inspection]]'''''
| colspan="2" style="background:#DCDCDC;" align="center" + |'''''[[Inspection (medicine)|Inspection]]'''''
|
| style="background:#F5F5F5;" + |
* Patient in left lateral decubitus, hips 90° flexed
* Patient in left lateral decubitus, hips 90° flexed
* Looking to the [[Perineal|perineal area]] under reasonable light
* Looking to the [[Perineal|perineal area]] under reasonable light
|
| style="background:#F5F5F5;" + |
* Skin [[excoriation]]
* Skin [[excoriation]]
* [[Skin tags]]
* [[Skin tags]]
Line 49: Line 49:
* [[Hemorrhoids]]
* [[Hemorrhoids]]
|-
|-
| colspan="2" |[[Sensation|'''''External sensation''''']]
| colspan="2" style="background:#DCDCDC;" align="center" + |[[Sensation|'''''External sensation''''']]
|
| style="background:#F5F5F5;" + |
* Using a stick with cotton head
* Using a stick with cotton head
* Tapping and touching all 4 quadrants centripetally (anocutaneous reflex)
* Tapping and touching all 4 quadrants centripetally (anocutaneous reflex)
|
| style="background:#F5F5F5;" + |
* Slight [[contraction]] of the [[skin]] and the [[external anal sphincter]] (normal reflex)
* Slight [[contraction]] of the [[skin]] and the [[external anal sphincter]] (normal reflex)
* No [[contraction]] with cotton head but slight [[contraction]] with wooden head (decreased reflex)
* No [[contraction]] with cotton head but slight [[contraction]] with wooden head (decreased reflex)
* No [[contraction]] with either of heads (absent reflex)
* No [[contraction]] with either of heads (absent reflex)
|-
|-
| rowspan="4" |'''''Internal examination'''''
| rowspan="4" style="background:#DCDCDC;" align="center" + |'''''Internal examination'''''
| colspan="1" rowspan="1" |Digital palpation
| colspan="1" rowspan="1" style="background:#DCDCDC;" align="center" + |Digital palpation
|
| style="background:#F5F5F5;" + |
* Inserting the index finger into the patient [[anus]]
* Inserting the index finger into the patient [[anus]]
* Palpating the parts, such as [[mucosa]], [[muscle]], [[bone]], [[uterus]], or [[prostate]]
* Palpating the parts, such as [[mucosa]], [[muscle]], [[bone]], [[uterus]], or [[prostate]]
|
| style="background:#F5F5F5;" + |
* [[Tenderness]]
* [[Tenderness]]
* [[Mass]]
* [[Mass]]
Line 69: Line 69:
* [[Stool]] consistency
* [[Stool]] consistency
|-
|-
|[[Sphincter]] tonometry
| style="background:#DCDCDC;" align="center" + |[[Sphincter]] tonometry
|
| style="background:#F5F5F5;" + |
* Evaluating the resting tone of the [[anal sphincter]]
* Evaluating the resting tone of the [[anal sphincter]]
|
| style="background:#F5F5F5;" + |
* Normal
* Normal
* Decreased
* Decreased
* Increased
* Increased
|-
|-
| colspan="1" rowspan="1" |Squeeze maneuver
| colspan="1" rowspan="1" style="background:#DCDCDC;" align="center" + |Squeeze maneuver
|
| style="background:#F5F5F5;" + |
* Evaluating the voluntary squeezing pressure of the [[anal sphincter]]
* Evaluating the voluntary squeezing pressure of the [[anal sphincter]]
* Asking to hold up to 30 seconds
* Asking to hold up to 30 seconds
|
| style="background:#F5F5F5;" + |
* Normal
* Normal
* Decreased
* Decreased
* Increased
* Increased
|-
|-
| colspan="1" rowspan="1" |[[Defecation]] maneuver
| colspan="1" rowspan="1" style="background:#DCDCDC;" align="center" + |[[Defecation]] maneuver
|
| style="background:#F5F5F5;" + |
* Asking to push as if to defecate
* Asking to push as if to defecate
* Evaluating the push effort with a hand on the [[abdomen]]  
* Evaluating the push effort with a hand on the [[abdomen]]  
|
| style="background:#F5F5F5;" + |
* Push effort (Normal, decreased, excessive)
* Push effort (Normal, decreased, excessive)
* [[Anal]] relaxation (normal, impaired, paradoxical contraction)
* [[Anal]] relaxation (normal, impaired, paradoxical contraction)

Revision as of 17:16, 9 January 2018

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

Overview

Physical examination of patients with constipation is usually remarkable for anal fissure or palpable lumpy mass in abdomen (particularly in left quadrant). The presence of thrombosed external hemorrhoids, skin tags, rectal prolapse, anal fissure, anal warts, excoriation or evidence of pruritus ani due to fecal soiling on physical examination are suggestive of constipation. Patients with chronic constipation usually appear to be discomfort while sitting due to anal pain.

Physical Examination

Appearance of the Patient

  • Patients with chronic constipation usually appear to be discomfort while sitting due to anal pain

Skin

HEENT

Neck

Abdomen

Neuromuscular

Digital rectal examination (DRE)

Method and findings of digital rectal examination include:[2]

DRE steps respectively Method Findings
Inspection
  • Patient in left lateral decubitus, hips 90° flexed
  • Looking to the perineal area under reasonable light
External sensation
  • Using a stick with cotton head
  • Tapping and touching all 4 quadrants centripetally (anocutaneous reflex)
Internal examination Digital palpation
Sphincter tonometry
  • Normal
  • Decreased
  • Increased
Squeeze maneuver
  • Evaluating the voluntary squeezing pressure of the anal sphincter
  • Asking to hold up to 30 seconds
  • Normal
  • Decreased
  • Increased
Defecation maneuver
  • Asking to push as if to defecate
  • Evaluating the push effort with a hand on the abdomen
  • Push effort (Normal, decreased, excessive)
  • Anal relaxation (normal, impaired, paradoxical contraction)
  • Perineal descent (Normal, excessive, absent)

References

  1. ↑ Rao SS, Meduri K (2011). "What is necessary to diagnose constipation?". Best Pract Res Clin Gastroenterol. 25 (1): 127–40. doi:10.1016/j.bpg.2010.11.001. PMC 3063397. PMID 21382584.
  2. ↑ Tantiphlachiva K, Rao P, Attaluri A, Rao SS (2010). "Digital rectal examination is a useful tool for identifying patients with dyssynergia". Clin. Gastroenterol. Hepatol. 8 (11): 955–60. doi:10.1016/j.cgh.2010.06.031. PMID 20656061.


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