Diagnostic Tests for Constipation
Constipation: Diagnostic Tests
The list of diagnostic tests
mentioned in various sources as
used in the diagnosis of Constipation
includes:
Constipation Tests: Book Excerpts
Home Diagnostic Testing
These home medical tests may be relevant to Constipation:
- Colon & Rectal Cancer: Home Testing
- Food Allergies & Intolerances: Home Testing:
- Digestive-Related Home Testing:
Constipation Diagnosis: Book Excerpts
Tests and diagnosis discussion for Constipation:
Most people do not need extensive testing and
can be treated with changes in diet and exercise. For example, in young
people with mild symptoms, a medical history and physical examination may
be all the doctor needs to suggest successful treatment. The tests the
doctor performs depends on the duration and severity of the constipation,
the person's age, and whether there is blood in stools, recent changes in
bowel movements, or weight loss.
Medical History
The doctor may ask a patient to describe his or
her constipation, including duration of symptoms, frequency of bowel
movements, consistency of stools, presence of blood in the stool, and
toilet habits (how often and where one has bowel movements). Recording
eating habits, medication, and level of physical activity or exercise also
helps the doctor determine the cause of constipation.
Physical Examination
A physical exam may include a digital rectal
exam with a gloved, lubricated finger to evaluate the tone of the muscle
that closes off the anus (anal sphincter) and to detect tenderness,
obstruction, or blood. In some cases, blood and thyroid tests may be
necessary.
Extensive testing usually is reserved for people with severe symptoms,
for those with sudden changes in number and consistency of bowel movements
or blood in the stool, and for older adults. Because of an increased risk
of colorectal cancer in older adults, the doctor may use these tests to
rule out a diagnosis of cancer:
- Barium enema x-ray
- Sigmoidoscopy or colonoscopy
- Colorectal transit study
- Anorectal function tests.
Barium Enema X-Ray
A barium enema x-ray involves viewing the
rectum, colon, and lower part of the small intestine to locate any
problems. This part of the digestive tract is known as the bowel. This
test may show intestinal obstruction and Hirschsprung's disease, a lack of
nerves within the colon.
The night before the test, bowel cleansing, also called bowel prep, is
necessary to clear the lower digestive tract. The patient drinks 8 ounces
of a special liquid every 15 minutes for about 4 hours. This liquid
flushes out the bowel. A clean bowel is important, because even a small
amount of stool in the colon can hide details and result in an inaccurate
exam.
Because the colon does not show up well on an x-ray, the doctor fills
the organs with a barium enema, a chalky liquid to make the area visible.
Once the mixture coats the organs, x-rays are taken that reveal their
shape and condition. The patient may feel some abdominal cramping when the
barium fills the colon, but usually feels little discomfort after the
procedure. Stools may be a whitish color for a few days after the exam.
Sigmoidoscopy or Colonoscopy
An examination of the rectum and
lower colon (sigmoid) is called a sigmoidoscopy. An examination of the
rectum and entire colon is called a colonoscopy.
The night before a sigmoidoscopy, the patient usually has a liquid
dinner and takes an enema in the early morning. A light breakfast and a
cleansing enema an hour before the test may also be necessary.
To perform a sigmoidoscopy, the doctor uses a long, flexible tube with
a light on the end called a sigmoidoscope to view the rectum and lower
colon. First, the doctor examines the rectum with a gloved, lubricated
finger. Then, the sigmoidoscope is inserted through the anus into the
rectum and lower colon. The procedure may cause a mild sensation of
wanting to move the bowels and abdominal pressure. Sometimes the doctor
fills the organs with air to get a better view. The air may cause mild
cramping.
To perform a colonoscopy, the doctor uses a flexible tube with a light
on the end called a colonoscope to view the entire colon. This tube is
longer than a sigmoidoscope. The same bowel cleansing used for the barium
x-ray is needed to clear the bowel of waste. The patient is lightly
sedated before the exam. During the exam, the patient lies on his or her
side and the doctor inserts the tube through the anus and rectum into the
colon. If an abnormality is seen, the doctor can use the colonoscope to
remove a small piece of tissue for examination (biopsy). The patient may
feel gassy and bloated after the procedure.
Colorectal Transit Study
This test, reserved for those with
chronic constipation, shows how well food moves through the colon. The
patient swallows capsules containing small markers, which are visible on
x-ray. The movement of the markers through the colon is monitored with
abdominal x-rays taken several times 3 to 7 days after the capsule is
swallowed. The patient follows a high-fiber diet during the course of this
test.
Anorectal Function Tests
These tests diagnose constipation caused
by abnormal functioning of the anus or rectum (anorectal function).
Anorectal manometry evaluates anal sphincter muscle function. A catheter
or air-filled balloon inserted into the anus is slowly pulled back through
the sphincter muscle to measure muscle tone and contractions.
Defecography is an x-ray of the anorectal area that evaluates
completeness of stool elimination, identifies anorectal abnormalities, and
evaluates rectal muscle contractions and relaxation. During the exam, the
doctor fills the rectum with a soft paste that is the same consistency as
stool. The patient sits on a toilet positioned inside an x-ray machine and
then relaxes and squeezes the anus and expels the solution. The doctor
studies the x-rays for anorectal problems that occurred while the patient
emptied the paste.
(Source: excerpt from Constipation: NIDDK)
Diagnosis of Constipation: medical news summaries:
The following medical news items
are relevant to diagnosis of Constipation:
Diagnostic Tests for Constipation: Online Medical Books
16 MEDICAL BOOKS ONLINE!
Review excerpts from medical books online, free, without registration,
for more information about the diagnostic tests for Constipation.
CONSTIPATION:
DIAGNOSTIC WORKUP
(Algorithmic Diagnosis of Symptoms and Signs)
If the constipation is acute, a flat plate of the abdomen and a CBC would be in order to determine if the patient has intestinal obstruction. The workup of chronic constipation should include stool for occult blood, sigmoidoscopy, barium enema, or a colonoscopy. A chemistry panel and other diagnostic studies may be necessary to rule out systemic causes of constipation such as diabetes, hypothyroidism, and various conditions associated with hypercalcemia. If diagnostic tests yield no positive findings, referral to a psychiatrist or a gynecologist may be in order. A trial of a fiber diet may be helpful. At the same time, one should eliminate chronic laxative usage. Anorectal manometry will help diagnose rectal and anal sphincter dysfunction. Defecography will help diagnose anorectal dysfunction also. A neurologist should be consulted if urinary retention is also a problem.
» READ BOOK EXCERPT ONLINE »
Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
Constipation:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
Ask the patient to describe the frequency of his bowel movements and the size and consistency of his stools. How long has he had constipation? Acute constipation usually has a physiological cause such as an anal or rectal disorder. In a patient older than age 45, a recent onset of constipation may be an early sign of colorectal cancer. Conversely, chronic constipation typically has a functional cause and may be related to stress.
Does the patient have pain related to constipation? If so, when did he first notice the pain, and where is it located? Cramping abdominal pain and distention suggest obstipation — extreme, persistent constipation due to intestinal tract obstruction. Ask the patient if defecation worsens or helps relieve the pain. Defecation usually worsens pain, but with such disorders as irritable bowel syndrome, it may relieve it.
Ask the patient to describe a typical day's diet; estimate his daily fiber and fluid intake. Ask him about changes in eating habits, medication or alcohol use, or physical activity. Has he experienced recent emotional distress? Has constipation affected his family life or social contacts? Also, ask about his job and exercise pattern. A sedentary or stressful job can contribute to constipation.
Find out whether the patient has a history of GI, rectoanal, neurologic, or metabolic disorders; abdominal surgery; or radiation therapy. Then ask about the medications he's taking, including opioids and over-the-counter preparations, such as laxatives, mineral oil, stool softeners, and enemas.
Inspect the abdomen for distention or scars from previous surgery. Then auscultate for bowel sounds, and characterize their motility. Percuss all four quadrants, and gently palpate for abdominal tenderness, a palpable mass, and hepatomegaly. Next, examine the patient's rectum. Spread his buttocks to expose the anus, and inspect for inflammation, lesions, scars, fissures, and external hemorrhoids. Use a disposable glove and lubricant to palpate the anal sphincter for laxity or stricture. Also, palpate for rectal masses and fecal impaction. Finally, obtain a stool sample and test it for occult blood.
As you assess the patient, remember that constipation can result from several life-threatening disorders, such as an acute intestinal obstruction and mesenteric artery ischemia, but it doesn't herald these conditions.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Constipation:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
Ask the patient to describe the frequency of his bowel movements and the size and consistency of his stools. How long has he had constipation? Acute constipation usually has an organic cause, such as an anal or rectal disorder. In a patient over age 45, a recent onset of constipation may be an early sign of colorectal cancer. Conversely, chronic constipation typically has a functional cause and may be related to stress.
Does the patient have pain related to constipation? If so, when did he first notice the pain, and where is it located? Cramping abdominal pain and distention suggest obstipation—extreme, persistent constipation due to intestinal tract obstruction. Ask the patient if defecation worsens or helps relieve the pain. Defecation usually worsens the pain, but in disorders such as irritable bowel syndrome, it may relieve it.
Ask the patient to describe a typical day’s menu; estimate his daily fiber and fluid intake. Ask him, too, about any changes in eating habits, medication or alcohol use, or physical activity. Has he experienced recent emotional distress? Has constipation affected his family life or social contacts? Also, ask about his job. A sedentary or stressful job can contribute to constipation.
Find out whether the patient has a history of GI, rectoanal, neurologic, or metabolic disorders; abdominal surgery; or radiation therapy. Then ask about the medications he’s taking, including over-the-counter preparations, such as laxatives, mineral oil, stool softeners, and enemas.
Inspect the abdomen for distention or scars from previous surgery. Then auscultate for bowel sounds, and characterize their motility. Percuss all four quadrants, and gently palpate for abdominal tenderness, a palpable mass, and hepatomegaly. Next, examine the patient’s rectum. Spread his buttocks to expose the anus, and inspect for inflammation, lesions, scars, fissures, and external hemorrhoids. Use a disposable glove and lubricant to palpate the anal sphincter for laxity or stricture. Also palpate for rectal masses and fecal impaction. Finally, obtain a stool specimen and test it for occult blood.
As you assess the patient, remember that constipation can result from several life-threatening disorders, such as acute intestinal obstruction and mesenteric artery ischemia, but it doesn’t herald these conditions.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Constipation:
Physical examination
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
Undertake a general physical examination looking for the stigmata of the associated constitutional illnesses mentioned in the MADE-O-FUN acrostic. Target the abdominal examination specifically for masses or abdominal tenderness and the rectal examination for fecal occult blood, rectal tone, rectal masses, rectal foreign body, impaction, anal fissure, hemorrhoids, or rectocoele—essential parts of the evaluation.
Diagnostic testing
Laboratory evaluation should consist of fecal occult blood testing (FOBT) looking for rectal bleeding; serum potassium and calcium to rule out hypokalemia and hypercalcemia (both associated with decreased colonic tone); serum glucose to evaluate possible diabetes; complete blood count looking for anemia (possibly related to chronic GI blood loss from tumor); blood urea nitrogen, serum creatinine, or both to rule out renal failure; and thyroid stimulating hormone to evaluate for hypothyroidism.
Visualize the lower colon via flexible sigmoidoscopy in patients aged more than 40 years whose constipation is of recent origin. Flexible sigmoidoscopy alone is insufficient for patients whose findings could suggest colonic neoplasia (melena, positive FOBT, hematochezia, abdominal mass, unexplained weight loss, or unexplained anemia). These patients should be offered either (a) colonoscopy or (b) barium enema plus flexible sigmoidoscopy.
Diagnostic assessment
The key diagnostic task in adults presenting with constipation is identifying those occasional patients whose constipation is caused by colorectal cancer. Because survival from colon cancer is directly related to the stage of the disease at time of diagnosis (3), patients whose history, examination, or laboratory findings are more suggestive of this diagnosis merit prompt investigation, including referral if necessary.
For patients whose constipation can be related to a particular systemic disease (e.g., hypercalcemia or hypothyroidism) or the use of particular medications (e.g., clonidine or an aluminum-containing antacid), identifying that link can be instrumental in ensuring that inciting issues are appropriately addressed in the management of the patient as a whole entity and not just as “a colon.”
In that greater host of patients whose initial evaluation suggests a more benign cause of constipation, or for whom constipation seems to be an incidental feature in an otherwise well individual, the decision to proceed with colonic visualization, or to begin a search for more unusual causes (the “U” in the MADE-O-FUN acrostic) will depend on the degree to which the constipation subjectively has an impact on the patient’s ability to live a fulfilling, happy, and rewarding life.
References
1. Drossman DA, McKee DC, Sandler RS, et al. Bowel patterns among subjects not seeking health care. Use of a questionnaire to identify a population with bowel dysfunction. Gastroenterology 1982;83:529–534.
2. Sonnenberg A, Koch TR. Physician visits in the United States for constipation: 1958–1986. Dig Dis Sci 1989;34:606–611.
3. Steele G. Colorectal cancer. In: Murphy GP, Lawrence W, Lenhad RE, eds. American Cancer Society textbook of clinical oncology, 2nd ed. Atlanta: The American Cancer Society, 1995:Chap 14.
» READ BOOK EXCERPT ONLINE »
Source: The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter, 2000
Constipation:
Diagnostic Approach
(Field Guide to Bedside Diagnosis)
Determine what the patient means by constipation. Patients are bothered by straining, excessively hard stools, unproductive urges, infrequency, and a feeling of incomplete evacuation.
With recent-onset constipation, seek an obstructing lesion, such as colon cancer, stricture, diverticular disease, inflammatory bowel disease, or foreign body. Hard stool in the vault rules out mechanical obstruction and suggests impaired emptying of the rectal vault. A change in stool caliber is more often caused by a tight sphincter than an “apple core” lesion.
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 2007
Constipation:
Physical assessment
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Inspect the abdomen for distention or scars from previous surgery. Then auscultate for bowel sounds, and characterize their motility. Percuss all four quadrants, and gently palpate for abdominal tenderness, a palpable mass, and hepatomegaly. Next, examine the patient’s rectum. Spread his buttocks to expose the anus, and inspect for inflammation, lesions, scars, fissures, and external hemorrhoids. Use a disposable glove and lubricant to palpate the anal sphincter for laxity or stricture. Also, palpate for rectal masses and fecal impaction. Finally, obtain a stool specimen and test it for occult blood.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Constipation:
Diagnostic Approach
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)
Diagnosisof many causes of constipation can be made by history and physicalexam.Age is a key factor. Although neonatesare more likely to have anatomic cause, most common causes in infantsand children are inadequate fluid and fiber in diet and combinationof developmental, situational, and psychologic factors.Physical exam is usually normal withmild constipation, whereas with severe constipation, stool is oftenpalpable in lower left quadrant and rectum is filled with hard feces.Abdominal radiograph shows presenceof stool, its extent, and whether lower spine is normal.If constipation fails to improve withusual therapy of adequate fluid intake, high-fiber diet, and laxatives,other disorders (e.g., congenital aganglionic megacolon) shouldbe suspected.
» READ BOOK EXCERPT ONLINE »
Source: The Diagnostic Approach to Symptoms and Signs in Pediatrics, 2006
Constipation:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
Ask the patient to describe the frequency of his bowel movements and the size and consistency of his stools. How long has he had constipation? Acute constipation usually has a physiological cause such as an anal or rectal disorder. In a patient older than age 45, a recent onset of constipation may be an early sign of colorectal cancer. Conversely, chronic constipation typically has a functional cause and may be related to stress.
Does the patient have pain related to constipation? If so, when did he first notice the pain, and where is it located? Cramping abdominal pain and distention suggest obstipation—extreme, persistent constipation due to intestinal tract obstruction. Ask the patient if defecation worsens or helps relieve the pain. Defecation usually worsens pain, but with such disorders as irritable bowel syndrome, it may relieve it.
Ask the patient to describe a typical day's diet; estimate his daily fiber and fluid intake. Ask him about recent changes in eating habits, medication or alcohol use, or physical activity. Has he experienced recent emotional distress? Has constipation affected his family life or social contacts? Also ask about his job and exercise pattern. A sedentary or stressful job can contribute to constipation.
Find out whether the patient has a history of GI, rectoanal, neurologic, or metabolic disorders; abdominal surgery; or radiation therapy. Then ask about the medications he's taking, including opioids and over-the-counter preparations, such as laxatives, mineral oil, stool softeners, and enemas.
Inspect the abdomen for distention or scars from previous surgery. Then auscultate for bowel sounds, and characterize their motility. Percuss all four quadrants, and gently palpate for abdominal tenderness, a palpable mass, and hepatomegaly. Next, examine the patient's rectum. Spread his buttocks to expose the anus, and inspect for inflammation, lesions, scars, fissures, and external hemorrhoids. Use a disposable glove and lubricant to palpate the anal sphincter for laxity or stricture. Also palpate for rectal masses and fecal impaction. Finally, obtain a stool sample and test it for occult blood.
As you assess the patient, remember that constipation can result from several life-threatening disorders, such as an acute intestinal obstruction and mesenteric artery ischemia, but it doesn't herald these conditions.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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