​Symptoms and Signs – Differential Diagnosis of Adult Constipation

​Symptoms and Signs – Differential Diagnosis of Adult Constipation 
NO GROSS STRUCTURAL ABNORMALITY
• Inadequate fiber intake
• Irritable bowel syndrome (associated with abdominal pain) or
functional constipation
• Idiopathic slow-transit constipation
• “Obstructed defecation”: pelvic floor dysfunction (or dyssynergia)
STRUCTURAL DISORDERS
• Anal fissure, infection, or stenosis
• Colon cancer or stricture
• Aganglionosis or abnormal myenteric plexus
• Hirschsprung’s disease
• Chagas’ disease
• Neuropathic pseudo-obstruction
• Abnormal colonic muscle
• Myopathy
• Dystrophia myotonica
• Systemic sclerosis
• Idiopathic megarectum or megacolon
• Proximal megacolon
NEUROLOGIC CAUSES
• Diabetic autonomic neuropathy
• Damage to the sacral parasympathetic outflow
• Spinal cord damage or disease (e.g., multiple sclerosis)
• Parkinson’s disease
• Blunting of consciousness, mental retardation, psychosis
• Pain induced by straining (e.g., sciatic nerve compression)
ENDOCRINE OR METABOLIC CAUSES
• Hypothyroidism
• Hypercalcemia
• Porphyria
• Pregnancy
PSYCHOLOGICAL DISORDERS
• Depression
• Anorexia nervosa
• Denied bowel habit
DRUG SIDE EFFECTS