II. Signs and Symptoms suggestive of organic cause

  1. See Constipation for red flag symptoms

III. Causes

  1. See Constipation Causes
  2. Common
    1. Colorectal carcinoma
    2. Diverticulitis
    3. Sigmoid or cecal Volvulus
    4. Fecal Impaction
  3. Uncommon
    1. Adhesions
    2. Hernia
    3. Pelvic abscess
    4. Intestinal foreign body

IV. Types: Functional causes (not organic)

  1. Normal Transit Constipation
    1. Perception of Constipation despite normal stool transit
    2. Associated with psychological stress
    3. Responds to fiber supplementation with adequate hydration
  2. Slow Transit Constipation
    1. Prolonged stool transit (more common in young women)
    2. Diagnosed with 6 of 24 Sitzmark markers visible on XRay at 120 hours post ingestion
    3. Related to decreased meal related peristalsis
    4. Refractory to dulocolax, Cholinergics, fiber
    5. May respond to biofeedback
  3. Outlet Constipation (pelvic floor dysfunction)
    1. Stool not expelled when reaches Rectum
    2. Symptoms include excessive straining at soft stool, sometimes requiring disimpaction
    3. Responds to biofeedback and Relaxation Techniques

V. Evaluation

  1. See Constipation for history and examination
  2. Examination should include Fecal Occult Blood Test

VII. Diagnostics: Initial

  1. XRay: Flat and Upright Abdomen
    1. Shows level of fecal obstruction
  2. Colonoscopy (preferred)
  3. Flexible Sigmoidoscopy (if Colonoscopy not available)
  4. Barium Enema (performed with Flexible Sigmoidoscopy)
    1. Abrupt termination of barium suggests Colon Cancer
    2. Smooth tapering of barium: sigmoid or cecal Volvulus
    3. Colonic narrowing with "saw-tooth": Diverticulitis
  5. CT Abdomen

VIII. Diagnostics: Other Testing

  1. Anal Manometry
    1. Detects Hirschsprung's Disease
    2. Also detects pelvic floor dysfunction (high pressure)
  2. Balloon insertion
    1. Evaluates rectal emptying
    2. Abnormal in pelvic floor dysfunction
  3. Defecography (fluoroscopy)
    1. Detects pelvic floor dysfunction
  4. Colonic transit study (XRay with radiopaque Sitzmark markers)
    1. Markers should pass by Day 5 in normal patients
    2. Detects slow colonic transit
    3. Detects pelvic outlet obstruction

IX. Management

  1. Evaluate and treat underlying cause
  2. If no cause identified, then consider empiric therapy
    1. See Functional Constipation

X. References

  1. Cheskin (1995) in Ambulatory Medicine, p. 476-81
  2. Friedman (1991) Problem Oriented Diagnosis, p. 192-4
  3. Sartor in Dornbrand (1992) Ambulatory Care, p. 221-5
  4. Arce (2002) Am Fam Physician 65(11):2283-90 [PubMed]
  5. Borum (2001) Prim Care 28(3):577-90 [PubMed]
  6. Wald (2000) Med Clin North Am 84(5):1231-46 [PubMed]

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Ontology: Acute constipation (C0401148)

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)