Work-Up of the Constipated Patient

ABSTRACT

Constipation is a common problem. Evaluation of patients should include a detailed history and clinical examination followed by radiologic and physiologic testing. The order of testing is dependent on patient symptoms and physician preference. The options are described along with their limitations.

KEYWORDS

Constipation - evaluation - transit studies

REFERENCES

• 1 Connell A M, Hilton C, Irvine G, Lennard-Jones J E, Misiewicz J J. Variation of bowel habit in two population samples.  BMJ. 1965;  2 1095-1099
• 2 Milne J S, Williamson J. Bowel habit in older people.  Geront Clin. 1972;  14 56-60
• 3 Everhart J E, Go V L, Johannes R S, Fitzsimmons S C, Roth H P, White L R. A longitudinal survey of self-reported bowel habits in the United States.  Dig Dis Sci. 1989;  34 1153-1162
• 4 Johanson J F, Sonnenberg A, Koch T R. Clinical epidemiology of chronic constipation.  J Clin Gastroenterol. 1989;  11 525-536
• 5 Whitehead W E, Drinkwater D, Cheskin L J, Heller B R, Schuster M M. Constipation in the elderly living at home: definition, prevalence, and relationship to lifestyle and health status.  J Am Geriatr Soc. 1989;  37 423-429
• 6 Campbell A J, Busby W J, Horwath C C. Factors associated with constipation in a community based sample of people aged 70 years and over.  J Epidemiol Community Health. 1993;  47 23-26
• 7 Stewart R B, Moore M T, Marks R G, Hale W E. Correlates of constipation in an ambulatory elderly population.  Am J Gastroenterol. 1992;  87 859-864
• 8 Shafer R B, Prentiss R A, Bond J H. Gastrointestinal transit in thyroid disease.  Gastroenterology. 1984;  86 852-855
• 9 Whitehead W E, Taitelbaum G, Wigley F M, Schuster M M. Rectosigmoid motility and myoelectric activity in progressive systemic sclerosis.  Gastroenterology. 1989;  96 428-432
• 10 Battle W M, Snape Jr W J, Wright S et al.. Abnormal colonic motility in progressive systemic sclerosis.  Ann Intern Med. 1981;  94 749-752
• 11 Hamel-Roy J, Devroede G, Arhan P, Tetreault L, Duranceau A, Menard H A. Comparative esophageal and anorectal motility in scleroderma.  Gastroenterology. 1985;  88 1-7
• 12 Glick M E, Meshkinpour H, Haldeman S, Bhatia N N, Bradley W E. Colonic dysfunction in multiple sclerosis.  Gastroenterology. 1982;  83 1002-1007
• 13 Longo W E, Ballantyne G H, Modlin I M. The colon, anorectum, and spinal cord patient: functional alterations of the denervated hindgut.  Dis Colon Rectum. 1989;  32 261-267
• 14 Valles M, Vidal J, Clave P, Merin F. Bowel dysfunction in patients with motor complete spinal cord injury: clinical, neurological, and pathophysiological associations.  Am J Gastroenterol. 2006;  101 2290-2299
• 15 Kuijpers H C. Application of the colorectal laboratory in diagnosis and treatment of functional constipation.  Dis Colon Rectum. 1990;  33 35-39
• 16 Turnbull G K, Lennard-Jones J E, Bartram C I. Failure of rectal expulsion as a cause of constipation: why fibre and laxatives sometimes fail.  Lancet. 1986;  1 767-769
• 17 Fisher S E, Breckon K, Andrews H A, Keighley M R. Psychiatric screening for patients with faecal incontinence or chronic constipation referred for surgical treatment.  Br J Surg. 1989;  76 352-355
• 18 Devroede G, Girard G, Bouchoucha M et al.. Idiopathic constipation by colonic dysfunction: relationship with personality and anxiety.  Dig Dis Sci. 1989;  34 1428-1433
• 19 Talley N J, Weaver A L, Zinsmeister A R, Melton III L J. Functional constipation and outlet delay: a population-based study.  Gastroenterology. 1993;  105 781-790
• 20 Moore-Gillon V. Constipation: what does the patient mean?.  J R Soc Med. 1984;  77 108-110
• 21 Rao S S, Ozturk R, Laine L. Clinical utility of diagnostic tests for constipation in adults: a systematic review.  Am J Gastroenterol. 2005;  100 1605-1615
• 22 Glia A, Lindberg G, Nilsson L H, Mihocsa L, Akerlund J E. Constipation assessed on the basis of colorectal physiology.  Scand J Gastroenterol. 1998;  33 1273-1279
• 23 Mertz H, Naliboff B, Mayer E A. Symptoms and physiology in severe chronic constipation.  Am J Gastroenterol. 1999;  94 131-138
• 24 Van Der Sijp J R, Kamm M A, Nightingale J M et al.. Disturbed gastric and small bowel transit in severe idiopathic constipation.  Dig Dis Sci. 1993;  38 837-844
• 25 Jorge J M, Habr-Gama A, Wexner S D. Clinical applications and techniques of cinedefecography.  Am J Surg. 2001;  182 93-101
• 26 Mahieu P, Pringot J, Bodart P. Defecography: I. Description of a new procedure and results in normal patients.  Gastrointest Radiol. 1984;  9 247-251
• 27 Dvorkin L S, Gladman M A, Epstein J et al.. Rectal intussusception in symptomatic patients is different from that in asymptomatic volunteers.  Br J Surg. 2005;  92 866-872
• 28 Halligan S, Malouf A, Vartram C I et al.. Predictive value of impaired evacuation at proctography in diagnosing anismus.  AJR Am J Roentgenol. 2001;  177 633-636
• 29 Pannu H K, Kaufman H S, Cundiff G W et al.. Dynamic MR imaging of pelvic organ prolapse: spectrum of abnormalities.  Radiographics. 2000;  20 1567-1582
• 30 Stoker J, Halligan S, Bartram C I. Pelvic floor imaging.  Radiology. 2001;  218 621-641
• 31 Fletcher J G, Busse R F, Riederer S J et al.. Magnetic resonance imaging of anatomic and dynamic defects of the pelvic floor in defecatory disorders.  Gastroenterology. 2003;  98 399-411
• 32 Matsuoka H, Wexner S D, Desai M B et al.. A comparison between dynamic pelvic magnetic resonance imaging and videoproctography in patients with constipation.  Dis Colon Rectum. 2001;  44 571-576
• 33 Snooks S J, Barnes P R, Swash M, Henry M M. Damage to the innervation of the pelvic floor musculature in chronic constipation.  Gastroenterology. 1985;  89 977-981
• 34 Jones P N, Lubowski D Z, Swash M, Henry M M. Is paradoxical contraction of puborectalis muscle of functional importance?.  Dis Colon Rectum. 1987;  30 667-670
• 35 Lopez A, Nilsson B Y, Mellgren A, Zetterstrom J, Holmstrom B. Electomyography of the external anal sphincter: comparison between needle and surface electrodes.  Dis Colon Rectum. 1999;  42 482-485
• 36 Pfeifer J, Teoh T A, Salanga V D, Agachan F, Wexner S D. Comparative study between intra-anal sponge and needle electrode for electromyographic evaluation of constipated patients.  Dis Colon Rectum. 1998;  41 1153-1157
• 37 Minguez M, Herroros B, Sanchiz V et al.. Predictive value of the balloon expulsion test for excluding the diagnosis of pelvic floor dyssynergia in constipation.  Gastroenterology. 2004;  126 57-62
• 38 Fleshman J W, Dreznik Z, Cohen E, Fry R D, Kodner I J. Balloon expulsion test facilitates diagnosis of pelvic floor outlet obstruction due to nonrelaxing puborectalis muscle.  Dis Colon Rectum. 1992;  35 1019-1025
• 39 Wald A, Hinds J P, Caruana B J. Psychological and physiological characteristics of patients with severe idiopathic constipation.  Gastroenterology. 1989;  97 932-937