II. Signs and Symptoms suggestive of organic cause
- See Constipation for red flag symptoms
III. Causes
- See Constipation Causes
- See Functional Constipation (Chronic Constipation)
- Common
- Colorectal Carcinoma
- Diverticulitis
- Sigmoid or cecal Volvulus
- Fecal Impaction
- Uncommon
- Adhesions
- Hernia
- Pelvic abscess
- Intestinal foreign body
IV. Evaluation
- See Constipation for history and examination
- Examination should include Fecal Occult Blood Test
V. Labs
VI. Diagnostics: Initial
- XRay: Flat and Upright Abdomen
- Shows level of fecal obstruction
- Colonoscopy (preferred)
- Flexible Sigmoidoscopy (if Colonoscopy not available)
-
Barium Enema (performed with Flexible Sigmoidoscopy)
- Abrupt termination of barium suggests Colon Cancer
- Smooth tapering of barium: sigmoid or cecal Volvulus
- Colonic narrowing with "saw-tooth": Diverticulitis
- CT Abdomen
VII. Diagnostics: Other Testing
- Anal Manometry
- Detects Hirschsprung's Disease
- Also detects Pelvic Floor Dysfunction (high pressure)
- Balloon insertion
- Evaluates rectal emptying
- Abnormal in Pelvic Floor Dysfunction
- Defecography (fluoroscopy)
- Detects Pelvic Floor Dysfunction
- Colonic transit study (XRay with radiopaque Sitzmark markers)
- Markers should pass by Day 5 in normal patients
- Detects slow colonic transit
- Detects pelvic outlet obstruction
VIII. Management
- Evaluate and treat underlying cause
- If no cause identified, then consider empiric therapy
IX. References
- Cheskin (1995) in Ambulatory Medicine, p. 476-81
- Friedman (1991) Problem Oriented Diagnosis, p. 192-4
- Sartor in Dornbrand (1992) Ambulatory Care, p. 221-5
- Arce (2002) Am Fam Physician 65(11):2283-90 [PubMed]
- Borum (2001) Prim Care 28(3):577-90 [PubMed]
- Wald (2000) Med Clin North Am 84(5):1231-46 [PubMed]
Images: Related links to external sites (from Bing)
Related Studies
| Concepts | Sign or Symptom (T184) |
| SnomedCT | 197119006 |
| English | acute constipation, Acute constipation, Acute constipation (disorder), Acute constipation (finding) |
| Spanish | constipación aguda, estreñimiento agudo, estreñimiento agudo (hallazgo), estreñimiento agudo (trastorno) |
