Constipation differential diagnosis

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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

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

• 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 Diseases that Cause Constipation

Diseases	History and Symptoms							Physical Examination				Laboratory Findings					Other Findings	Diagnostic study of choice
												Electrolyte tests			Biochemical tests
	GI symptoms			Extra GI symptoms				Abnormal gait	Anal protruding mass	DRE	Deep tendon reflex	Mg	K	Ca	FBS	TSH
	Dysphagia	Abdominal pain	Anal pain	Weight loss	Polyphagia, Polyuria, Polydipsia	Dry skin	Tremor
Malignancy	-	-	+/-	++	-	-	-	-	-	Empty rectum	Normal	Normal	Normal	↓↑	Normal	Normal	Acute change in bowel habits Rectal bleeding Anemia	Rectosigmoidoscopy with biopsy
Diabetic autonomic neuropathy	-	-	-	+	++	+/-	-	+/-	-	Normal	↓	Normal	Normal	Normal	↑↑	Normal	Distal neuropathy Gastroparesis Nausea and vomiting	FBS and HbA1C
Irritable bowel syndrome (IBS)	-	+	+/-	-	-	-	-	-	-	Normal	Normal	Normal	Normal	Normal	Normal	Normal	Frequent change in bowel habit Abdominal pain alleviating with bowel movement	Rolling out other pathophysiologies
Rectocele	-	-	-	-	-	-	-	-	+	Bulging rectum	Normal	Normal	Normal	Normal	Normal	Normal	Obstruction Absence of defecation and gas passing	Anoscopy
Anal fissure	-	-	+++	-	-	-	-	-	-	Increased sphincter tone Anal lesion	Normal	Normal	Normal	Normal	Normal	Normal	Rectal bleeding after defecation	DRE
Anismus	-	-	+	-	-	-	-	-	-	Increased sphincter tone	Normal	Normal	Normal	Normal	Normal	Normal	Absence of defecation and gas passing	DRE
Systemic sclerosis	+	-	-	-	-	+	-	-	-	Normal	Normal	Normal	Normal	Normal	Normal	Normal	Raynaud phenomenon Fingertip ulcer	Clinical characteristics Anti-centromere and anti-Scl-70 antibodies
Hypothyroidism	-	-	-	-	-	+	-	-	-	Normal	↓↓	Normal	Normal	Normal	Normal	↑↑	Weakness and fatigue Dysmenorrhea	Thyroid function tests (TFT)
Parkinson's disease	+/-	-	-	-	-	-	++	+	-	Normal	↑↑	Normal	Normal	Normal	Normal	Normal	Muscle stiffness Drooling	Brain MRI
Multiple sclerosis	+	-	-	-	-	-	+	+	-	Normal	↓↑	Normal	Normal	Normal	Normal	Normal	Blurred vision Erectile dysfunction	Brain MRI CSF biochemical profile
Hypomagnesemia	-	+	-	-	-	-	+	-	-	Normal	↓	↓↓	Normal	Normal	Normal	Normal	Nystagmus Seizure	Plasma Mg level
Hypocalcemia	-	+	-	-	-	-	-	-	-	Normal	↓	Normal	Normal	↓↓	Normal	Normal	Muscle weakness Dysesthesia	Plasma Ca level
Depression	-	-	-	+	-	-	-	-	-	Normal	Normal	Normal	Normal	Normal	Normal	Normal	Hopelessness Weakness and fatigue Depressed mood	Psychological examination
Pregnancy	-	-	-	-	-	-	-	-	-	Normal	Normal	Normal	Normal	Normal	Normal	Normal	Lower extremities edema Dyspnea Nausea and vomiting	Plasma βhCG Ultrasonography