Constipation

CLINICAL DIAGNOSTIC MANUAL

Constipation is a common disorder characterised by infrequent or difficult bowel movements, typically fewer than three times per week. It may be accompanied by pain during defecation, a sensation of incomplete evacuation, and hard, dry stools.

The causes of constipation are varied and include dietary factors, lifestyle changes, underlying medical conditions, and the use of certain medications. Identifying the underlying cause is crucial for providing appropriate treatment and improving the patient’s quality of life.

Pathology	Symptoms and Clinical Signs	Suspected Diagnosis	Confirmatory Diagnosis
Dietary changes	Constipation, hard stools, abdominal pain, recent changes in fibre intake	History of dietary changes, physical examination	Dietary evaluation, food diary
Lifestyle changes	Constipation, decreased physical activity, changes in daily routine	History of changes in physical activity and daily routine	Detailed medical history, exclusion of other causes
Environmental changes	Constipation, recent changes in environment (travel, relocation)	History of recent environmental changes	Detailed medical history, exclusion of other causes
Immobility	Constipation, decreased mobility, abdominal pain	History of prolonged immobility, physical examination	Medical history, mobility assessment
Medication-induced	Constipation, associated with starting a new medication, no other infectious symptoms	History of medication use, physical examination	Medication history review, discontinuation test
Anal fissure	Pain during defecation, blood in stools, severe anal pain	History of acute anal pain, physical examination	Physical examination, anoscopy
Haemorrhoids	Pain during defecation, rectal bleeding, anal itching, perianal mass	History of anal symptoms, physical examination	Physical examination, anoscopy
Secondary to low fluid intake	Constipation, hard stools, decreased fluid intake	History of low fluid intake, physical examination	Fluid intake assessment, fluid diary
Hypothyroidism	Constipation, fatigue, weight gain, dry skin, bradycardia	History of hypothyroid symptoms, physical examination	Thyroid function tests (TSH, free T4)
Rectal tumour	Constipation, rectal bleeding, abdominal pain, weight loss, sensation of rectal mass	History of gastrointestinal symptoms, physical examination	Colonoscopy, biopsy, abdominal CT scan
Colon carcinoma	Constipation, changes in bowel habits, rectal bleeding, weight loss, anaemia	History of gastrointestinal symptoms, physical examination	Colonoscopy, biopsy, abdominal CT scan
Other causes	Symptoms vary depending on underlying pathology, persistent constipation	Detailed medical history, physical examination	Specific tests based on clinical suspicion