DIAGNOSIS CHECKLIST
for Hard stool

Why: to determine if acute or chronic e.g. if acute may suggest intestinal obstruction or bowel cancer. If hard stools are chronic need to investigate the dietary history, emotional status and toilet habits. Frequency of bowel movements? - to establish severity.

Why: to establish if true constipation i.e. less than 3 stools per week or stools that are hard to evacuate.

Why: e.g. fast food is usually devoid of fiber; weight loss diets may be low in fiber; lack of dietary fiber in diet e.g. fruit, vegetables and wholemeal products.

Why: e.g. a common cause of chronic constipation or hard stools is the habitual neglect of the impulse to defecate leading to accumulation of large, dry faecal masses which causes constant rectal distension from feces and consequent reduced awareness of rectal fullness.

Why: e.g. certain conditions may predispose to constipation or hard stools including depression, hypothyroidism, hypocalcaemia ( low calcium in blood), diabetes, phaeochromocytoma, porphyria, hypokalaemia (low potassium in blood).

Why: e.g. aganglionosis, Hirschsprung's disease, autonomic neuropathy, spinal cord injury, multiple sclerosis.

Why: e.g. difficult prolonged vaginal deliveries - damage to the pelvic floor muscles or nerves may cause constipation or hard stools.

Why: e.g. hard stools may arise from ingestion of drugs e.g. codeine, antidepressants, aluminium or calcium antacids, antispasmodics for ulcer or urinary incontinence; the chronic use of laxatives can also lead to lazy bowel.

Why: may suggest hemorrhoids or anal fissure. If defecation is painful it may cause you to delay moving your bowels due to fear of the pain which may further perpetuate the problem.

Why: may suggest colon cancer or diverticulitis.

Why: may suggest inflammatory bowel disease.

Why: may suggest constipation with overflow of liquid feces. This can occur in children and adults.

Why: e.g. abdominal pain, vomiting, loud bowel sounds.

Why: e.g. passage of pellet-like stools, alternating constipation and diarrhea, associated with abdominal pain which is relieved by defecation, passage of mucous per rectum, feeling of incomplete emptying of the rectum after defection and visible abdominal distention.

Why: e.g. may also have alternating constipation and diarrhea, rectal bleeding or bloody stool, weight loss.

Why: suggest neurological conditions.

Why: constipation or hard stools are a common problem in pregnancy.