Editing Constipation (section)

==Diagnosis==
[[File:Constipation(lots).png|thumb|Significant constipation in the plain X-ray of an 8-year-old]]
The diagnosis is typically made based on a person's description of the symptoms. Bowel movements that are difficult to pass, very firm, or made up of small hard pellets (like those excreted by rabbits) qualify as constipation, even if they occur every day. Constipation is traditionally defined as three or fewer bowel movements per week.<ref name=Jam2011/> Other symptoms related to constipation can include bloating, [[Abdominal distension|distension]], abdominal pain, headaches, a feeling of fatigue and nervous exhaustion, or a sense of incomplete emptying.<ref>[http://www.medicinenet.com/constipation/article.htm "Constipation"] {{webarchive|url=https://web.archive.org/web/20071130041024/http://www.medicinenet.com/constipation/article.htm |date=30 November 2007 }} MedicineNet</ref> Although constipation may be a diagnosis, it is typically viewed as a symptom that requires evaluation to discern a cause.

=== Description ===
Distinguish between acute (days to weeks) or chronic (months to years) onset of constipation because this information changes the [[differential diagnosis]]. This in the context of accompanied symptoms helps physicians discover the cause of constipation. People often describe their constipation as bowel movements that are difficult to pass, firm stool with lumpy or hard consistency, and excessive straining during bowel movements. Bloating, abdominal [[Abdominal distension|distension]], and abdominal pain often accompany constipation.<ref name=LTierneyBook>{{cite book|vauthors = Tierney LM, Henderson MC, Smetana GW|title=The patient history: an evidence-based approach to differential diagnosis|date=2012|publisher=McGraw-Hill Medical|location=New York|isbn=978-0-07-162494-7|page=Chapter 32|edition=2nd}}</ref> Chronic constipation (symptoms present at least three days per month for more than three months) associated with abdominal discomfort is often diagnosed as irritable bowel syndrome (IBS) when no obvious cause is found.<ref>{{cite journal|year=2006|title=Functional bowel disorders|journal=Gastroenterology|volume=130|issue=5|pages=1480–91|doi=10.1053/j.gastro.2005.11.061|pmid=16678561|vauthors=Longstreth GF, Thompson WG, Chey WD, Houghton LA, Mearin F, Spiller RC}}</ref>

Poor dietary habits, previous abdominal surgeries, and certain medical conditions can contribute to constipation. Diseases associated with constipation include [[hypothyroidism]], certain types of [[cancer]], and [[irritable bowel syndrome]]. Low fiber intake, inadequate amounts of fluids, poor ambulation or immobility, or medications can contribute to constipation.<ref name="walia"/><ref name="mccallum"/> Once the presence of constipation is identified based on a culmination of the symptoms described above, then the cause of constipation should be figured out.

Separating non-life-threatening from serious causes may be partly based on symptoms. For example, colon cancer may be suspected if a person has a family history of colon cancer, fever, weight loss, and rectal bleeding.<ref name=Jam2011/> Other alarming signs and symptoms include family or personal history of inflammatory bowel disease, age of onset over 50, change in stool caliber, nausea, vomiting, and neurological symptoms like weakness, numbness and difficulty urinating.<ref name=LTierneyBook/>

=== Examination ===
A physical examination should involve at least an abdominal exam and rectal exam. Abdominal exam may reveal an abdominal mass if there is significant stool burden and may reveal abdominal discomfort. [[Rectal examination]] gives an impression of the anal sphincter [[muscle tone|tone]] and whether the lower rectum contains any feces or not. Rectal examination also gives information on the consistency of the stool, the presence of hemorrhoids, blood and whether any [[perineum|perineal]] irregularities are present including skin tags, fissures, anal warts.<ref name="mccallum"/><ref name="walia"/><ref name=Jam2011/> Physical examination is done manually by a physician and is used to guide which diagnostic tests to order.

=== Diagnostic tests ===
Functional constipation is common and does not warrant diagnostic testing. Imaging and laboratory tests are typically recommended for those with alarm signs or symptoms.<ref name=Jam2011/>

The laboratory tests performed depends on the suspected underlying cause of the constipation. Tests may include CBC ([[complete blood count]]), thyroid function tests, serum calcium, serum potassium, etc.<ref name="walia"/><ref name=Jam2011/>

[[Abdominal radiography|Abdominal X-rays]] are generally only performed if bowel obstruction is suspected, may reveal extensive impacted fecal matter in the colon, and may confirm or rule out other causes of similar symptoms.<ref name="mccallum"/><ref name="walia"/>

Colonoscopy may be performed if an abnormality in the colon like a tumor is suspected.<ref name=Jam2011/> Other tests rarely ordered include [[anorectal manometry]], anal sphincter electromyography, and [[defecography]].<ref name="walia"/>

Colonic propagating pressure wave sequences (PSs) are responsible for discrete movements of the bowel contents and are vital for normal defecation. Deficiencies in PS frequency, amplitude, and extent of propagation are all implicated in severe defecatory dysfunction (SDD). Mechanisms that can normalize these aberrant motor patterns may help rectify the problem. Recently the novel therapy of [[sacral nerve stimulation]] (SNS) has been utilized for the treatment of severe constipation.<ref>{{Cite journal |author=Dinning PG |title=Colonic manometry and sacral nerve stimulation in patients with severe constipation |journal=Pelviperineology |volume=26 |issue=3 |pages=114–116 |date=September 2007 |url=http://www.pelviperineology.com/pelvis/severe_constipation_colonic_manometry_sacral_nerve_stimulation.html |archive-url=https://web.archive.org/web/20080212124726/http://www.pelviperineology.com/pelvis/severe_constipation_colonic_manometry_sacral_nerve_stimulation.html |archive-date=12 February 2008 }}</ref>

===Criteria===
The Rome III Criteria for functional constipation must include two or more of the following and present for the past three months, with symptoms starting for at least 6 months prior to diagnosis.<ref name=Jam2011/>
* Straining during defecation for at least 25% of bowel movements
* Lumpy or hard stools in at least 25% of defecations
* Sensation of incomplete evacuation for at least 25% of defecations
* Sensation of anorectal obstruction/blockage for at least 25% of defecations
* Manual maneuvers to facilitate at least 25% of defecations
* Fewer than 3 defecations per week
* Loose stools are rarely present without the use of laxatives
* There are insufficient criteria for irritable bowel syndrome