Constipation

Adult

Approach

  1. Red flags for colon cancer?

    • Sudden onset, severe constipation: FOBT and refer for colonoscopy if positive

    • Painless colorectal bleeding

      • Explore alternative diagnoses, e.g. anal fissure, hemorrhoids, anoreceptive intercourse

      • Refer for colonoscopy if age > 30 years and any of the following are true:

        • No alternative explanation

        • Persistent bleeding despite adequate treatment of alternative diagnosis

  2. Review risk factors and consider

    • Discontinuing offending medications

    • Obtaining HbA1c, TSH, UDS

  3. Treatment

    1. Trial of laxatives

    2. Laxatives ineffective

      • Initial test: Anorectal manometry and balloon expulsion test

      • Initial testing normal or inconclusive: Barium or MR defecography

Differential Diagnosis

Pediatric