Constipation (cont.)

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What are constipation symptoms?

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Symptoms of constipation include:

  • Infrequent bowel movements
  • Straining to have bowel movements
  • Hard and/or small stools
  • Sense of incomplete evacuation after bowel movements
  • Lower abdominal discomfort
  • Abdominal bloating, occasionally distension
  • Anal bleeding or fissures from the trauma caused by hard stools
  • Occasionally diarrhea due to obstruction of the colon by hard stool
  • Rarely colonic perforation
  • Psychological distress and/or obsession with having bowel movements
  • Possible aggravation of diverticular disease, hemorrhoids and rectal prolapse

How is constipation diagnosed (evaluated)?

A careful history and physical examination is important in all patients with constipation. There are many tests that can be used to evaluate constipation. Most patients need only a few basic tests. The other tests are reserved for individuals who have severe constipation or whose constipation does not respond easily to treatment.

Exams and tests

Medical History

A careful medical history from a patient with constipation is critical for many reasons, but particularly because it allows the physician to define the type of constipation. This, in turn, directs the diagnosis and treatment. For example, if defecation is painful, the physician knows to look for anal problems such as a narrowed anal sphincter or an anal fissure. If small stools are the problem, there is likely to be a lack of fiber in the diet. If the patient is experiencing significant straining, then pelvic floor dysfunction is likely.

The medical history also uncovers medications and diseases that can cause constipation. In these cases, the medications can be changed and the diseases can be treated.

A careful dietary history-which may require keeping a food diary for a week or two-can reveal a diet that is low in fiber and may direct the physician to recommend a high-fiber diet. A food diary also allows the physician to evaluate how well a patient increases his dietary fiber during treatment.

Physical examination

A physical examination may identify diseases (for example, scleroderma) that can cause constipation. A rectal examination with the finger may uncover a tight anal sphincter that may be making defecation difficult or it may find that the muscles of the pelvic floor do not relax normally. If a stool-filled colon can be felt through the abdominal wall, it suggests that constipation is severe. Stool in the rectum suggests a problem with the anal, rectal, or pelvic floor muscles.

Blood tests

Blood tests may be appropriate in evaluating patients with constipation. More specifically, blood tests for thyroid hormone (to detect hypothyroidism) and for calcium (to uncover excess parathyroid hormone) may be helpful.

Abdominal X-ray

Large amounts of stool in the colon usually can be visualized on simple X-ray films of the abdomen, and the more severe the constipation, the more stool is visualized.

Barium enema

A barium enema (lower gastrointestinal [GI] series) is an X-ray study in which liquid barium is inserted through the anus to fill the rectum and colon. The barium outlines the colon on the X-rays and defines the normal or abnormal anatomy of the colon and rectum. Tumors and narrowings (strictures) are among the abnormalities that can be detected with this test.

Medically Reviewed by a Doctor on 7/16/2015

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Constipation - Home Remedies and Treatments Question: What kinds of treatments such as home remedies, OTC medication, or other therapies have been effective for your constipation?
Constipation - Experience Question: Has your constipation ever limited you from performing daily activities? Work? Pleasure?
Constipation - Causes Question: If known, what is the cause of or reason for your constipation? Have you found a remedy?
Constipation - Fiber and Laxatives Question: What type of fiber or laxatives have you found helpful in treating constipation?
Constipation - Medication Causes Question: What medications or drugs cause constipation or make it worse?
Constipation - Symptoms Question: What symptoms did you experience with constipation?
Constipation - Prescription Drugs Question: What prescription drugs have helped with your chronic constipation?