Constipation DDx

Constipation – Differential Diagnosis

Common causes

• Simple constipation
• Irritable bowel syndrome
• Diverticular disease
• Painful ano-rectal conditions
• Hypothyroidism
• Behavioural (children)

Must Not Miss

• Colorectal cancer
• Intestinal obstruction
• Hirschsprung’s (children)

Easily missed

• Medication
  
• Hypercalcaemia

Red flags

• Persistent altered bowel habit > 50 years age
• Weight loss
• Rectal bleeding/Tenesmus
• Systemic features (fatigue, sweats, fever, malaise)
• Family history of bowel cancer
• Iron deficiency anaemia

Investigations to consider

• FBC, CRP/ESR
• U&Es, LFTs, TFTs, Bone profile, ferritin
• Faecal occult blood screen
• AXR
• Barium enema
• Sigmoidoscopy
• Colonoscopy
• CT/MRI scan