Diagnosis of Chronic Constipation
Patient History
The most common complaints of constipation are low frequency of stool passage and straining to pass stools. A more in depth understanding of the medical basis, or etiology, of chronic constipation requires more detailed diagnosis. The first step to diagnosis is a proper, detailed patient history. This is most important as patients do not, in general, report all symptoms spontaneously.
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For example, some patients take medications for secondary medical problems which can lead to constipation.
Digital Rectal Examination: A Valuable Test
Beyond patient history, the types of physical diagnostic tests are few but can provide important information. The digital rectal exam is a very simple test. It entails the patient lying on his or her side, and the physician inserting a gloved finger into the anorectal region in any attempt to detect physical abnormalities. The digital rectal exam is already a part of the regular physicial exam and is an easy way to get more clues about the underlying causes of chronic constipation.
Sigmoidoscopy
In order to detect physical abnormalities in the gastrointestinal tract beyond the anorectal area that can lead to chronic constipation, the physician may employ a sigmoidoscope. The sigmoidoscope is an optical device which can reach further into the rectal region, but stop short of entering the colon. Preparation for the sigmoidoscope will involve some degree of fasting, liquid dieting, use of enemas and laxatives. These preparative actions are aimed, to some degree, at clearing out the lower rectum for easy visualization with the sigmoidoscope.
Colonoscopy
An even more comprehensive view of the entire colon can be gained via a colonoscopy for diagnosing chronic constipation. In the event that constipation is due to disease affecting the colon, a colonoscopy can be warranted. For those over 50, diagnosis of constipation with a colonoscopy can be lumped with regular colonoscopies for bowel cancer. However, because colonoscopies are not only expensive and have limited utility in the majority of constipation cases, a colonoscopy is considered mostly superfluous.
Defecating Proctogram
A less invasive diagnostic procedure is a defecating proctogram, which is an x-ray of the rectal region during defecation. While less invasive physically, the test may be embarassing to patients as it requires them to bear down and eliminate a simulated stool. The simulated stool is also an oral contrast agent, composed of barium and a liquid, starchy substance. As the stool is eliminated into a special commode, x-rays visualize the rectal muscles in midst of contraction. Such tests can reveal physical problems such as prolapses that cause chronic constipation.
Ultrasound
Many people have seen ultrasound images of bellies of pregannt women. Ultrasound can also be used to image the anal or intestinal region for abnormalities. While ultrasound is an imaging technique similar to x-rays, the preparation still requires the insertion of a balloon probe to inflate the gastrointestinal tract. The insert procedure necessitates some usage of enemas to flush out the lower rectal region. Ultrasound reveals different things compared to x-rays and can be a more complete test for diagnosing chronic constipation.