Constipation physical examination

Constipation Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Constipation from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Diagnostic Study of Choice
History and Symptoms
Physical Examination
Laboratory Findings
Abdominal X Ray
CT
MRI
Ultrasound
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Constipation On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Constipation All Images X-rays Ultrasound CT Images 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

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 sit because of anal pain.

Physical Examination

• 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.

Appearance of the Patient

• Patients with chronic constipation usually appear to be discomfort while sit because of anal pain.

Skin

• Dry skin may be seen in systemic sclerosis

HEENT

• Extra-ocular movements may be abnormal

Neck

• Thyromegaly/thyroid nodules may be seen in hypothyroidism

Abdomen

• Abdominal distention
• Abdominal tenderness in the left lower abdominal quadrant
• A palpable abdominal mass in the left lower abdominal quadrant

Neuromuscular

• Patient is maybe not oriented to persons, place, and time
• Altered mental status
• Clonus may be present
• Hyperreflexia
• Positive (abnormal) Babinski
• Muscle rigidity
• Abnormal gait (Parkinsonian gait)
• Unilateral/bilateral tremor (pill-rolling)

Digital rectal examination (DRE)

DRE steps respectively		Method	Findings
Inspection		Patient in left lateral decubitus, hips 90° flexed Looking to the perineal area under reasonable light	Skin excoriation Skin tags Anal fissure Scars Hemorrhoids
External sensation		Using a stick with cotton head Tapping and touching all 4 quadrants centripetally (anocutaneous 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 either of heads (absent reflex)
Internal examination	Digital palpation	Inserting the index finger into the patient anus Palpating the parts, such as mucosa, muscle, bone, uterus, or prostate	Tenderness Mass Stricture Stool consistency
	Sphincter tonometry	Evaluating the resting tone of the anal sphincter	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)