Why You Need Constipation Assessment And Diagnosis

Ever been constipated? It sucks. It’s uncomfortable and makes you feel miserable. But constipation assessment and diagnosis is usually skipped over.

chronic constipation assessment and diagnosisConstipation is an extremely common problem – but there are many misconceptions about it. It doesn’t only refer to infrequent stools – but also may be experienced as hard, dry, difficult to pass stools. Additionally, there are different types of constipation – Primary or Secondary – and each one is caused by or associated with different things.

Identifying which type of constipation you are suffering from, and what may be causing it, is important in selecting the most effective treatment approach. So beginning with constipation assessment and diagnosis is key in identifying the most effective treatment approach.

Constipation Assessment and Diagnosis

How is constipation diagnosed – and how do you know which type of constipation you have?

A detailed digestive health history and related physical examination, is the place to begin for constipation assessment and diagnosis. A licensed MD or ND will typically be able to discern if constipation is acute or chronic, and more likely to be primary or secondary. Making this determination is important as a means of providing the most pertinent and useful treatment recommendations (treatment advice will differ depending on the cause).

constipation assessment and diagnosisA digital rectal examination may be an important component of this initial constipation assessment and diagnosis – and should be performed by your doctor in a clinical setting. Additional diagnostic assessment is typically a second step (if there are alarm features, or if initial treatment recommendations do not resolve constipation after 6-8 weeks), and may include:

  • Colonoscopy (a scope performed under sedation to examine the intestines)
  • Colonic Transit Study (measures the time it takes for food to move through the digestive system and exit as stool)
  • Tests to examine the function and tone of muscles and sphincters in the anus and rectum, responsible for the expulsion of stool
  • Bloodwork to rule out an underlying condition that may be associated with constipation
  • Dynamic pelvic MRI (MR defecography) is a newer modality that evaluates global pelvic floor anatomy and dynamic motion simultaneously – may be of use in assessing dyssenergia

Digestive Health History

constipation assessment and diagnosisYour healthcare provider should ask you about:
• your bowel habits (frequency, ease and quality of stool)
• when symptoms or a change in bowel habits began
• the frequency with which you experience symptoms
• the severity of symptoms
• any history of precipitating events that may have contributed
• your diet (in detail, including amounts of foods and beverages)
• your exercise habits
• any medications you may be taking or were taking prior to onset
• any obstacles or possible contributing factors (a work or school environment, stress management, avoidance of bathrooms, schedule)

Bristol Stool Chart

Initially, I ask my patients to keep a stool diary to help document the frequency and quality of stool (as most people can’t accurately document based on recall vs tracking). The Bristol Stool Chart is a good reference to use as a tool when charting. Type 1 (small hard lumps or pellets) and Type 2 (sausage-shaped and lumpy) are indicative of constipation.

Lab Tests

constipation assessment and diagnosisThe following labs may be considered if a secondary cause is suspected:
• CBC, serum ferritin – assess for anemia/iron deficiency
• Serum electrolytes (including calcium & magnesium) – assess for hypercalcemia
• Thyroid function tests, basal body temperature, history – assess for hypothyroidism
• Fasting blood sugar & Hemoglobin A1C – assess for diabetes
• An abdominal x-ray or barium enema may be requested – but may be of limited use (x-ray may be helpful in assessing obese patients where physical examination is difficult)
• A colonoscopy may be ordered if there are alarm features (see list below) or iron deficiency anemia, or if a patient is >50 years old with no prior screening for colorectal cancer

Alarm Features

The presence of alarm features may indicate a higher risk for a secondary cause of the constipation, and warrants referral to a gastroenterologist for further investigation (typically colonoscopy), or an ER visit in the case of bowel obstruction.
• Rectal bleeding
• Iron deficiency anemia
• A positive stool test for presence of blood
• Significant unexplained weight loss
• Recent onset, especially if over 50 years of age and not previously screened for colorectal cancer
• A change in the thickness/diameter of stool
• Signs of bowel obstruction (sudden onset of crampy abdominal pain that comes and goes, with constipation or inability to pass gas, distension, loss of appetite and/or vomiting)→go to your local ER for evaluation

Related Reading:
Conditions That May Cause Constipation
Constipation Treatment – Types of Laxatives, Safety & Effectiveness
Constipation Natural Treatment – Most Effective Natural & Home Remedies
Constipation & Diet – Best Foods for Constipation