Doctors perform a complete physical examination in order to identify possible causes of constipation. Most people with constipation do not need extensive testing and can be treated with changes in diet and exercise. However, the tests a doctor perform depend on the duration and severity of the constipation, patient age, and whether blood in stools, recent changes in bowel habits, or weight loss have occurred. It's recommended that you first see your family doctor for constipation, and then you may be referred to a GI specialist, radiologist, or colorectal surgeon if necessary.
The clinical definition of constipation requires that patients exhibit two of the following symptoms for at least 12 weeks (not necessarily consecutive) within the previous 12 months:
Your doctor will ask you to constipation, including duration of symptoms, frequency of bowel movements, consistency of stools, presence of blood in the stool, and toilet habits-how often and where one has bowel movements. A record of eating habits, medication, and level of physical activity will also help the doctor determine the cause of constipation.
A physical exam may include a digital rectal exam. During a rectal examination, the doctor inserts a gloved, lubricated finger into the anus to evaluate the tone of the muscle that closes off the anus (the sphincter) and to detect tenderness, obstruction, or blood. Depending on the results of the medical history and physical examination, a doctor may recommend a variety of tests help rule out structural or organic causes.
Blood and thyroid tests
In some cases, blood and thyroid tests may be necessary to look for thyroid disease and serum calcium or to rule out inflammatory, metabolic, and other disorders.
The doctor may also order one or more tests if a serious problem is suspected as the cause of constipation. Extensive testing usually is reserved for people with severe symptoms, for those with sudden changes in the number and consistency of bowel movements or blood in the stool, and older adults. Doctors also use additional tests to rule out a diagnosis of cancer. Additional tests used to evaluate constipation include:
Anorectal function tests - These tests diagnose constipation caused by abnormal functioning of the anus or rectum-also called anorectal function. Generally, the doctor inserts a small balloon into the anus to analyse sphincter muscle function.
- Anorectal manometry evaluates anal sphincter muscle function. For this test, a catheter or air-filled balloon is inserted into the anus and slowly pulled back through the sphincter muscle to measure muscle tone and contractions.
- Balloon expulsion tests consist of filling a balloon with varying amounts of water after it has been rectally inserted. Then the patient is asked to expel the balloon. The inability to expel a balloon filled with less than 150 mL of water may indicate a decrease in bowel function.
Barium enema x ray - This exam involves viewing the bowel to locate problems (the rectum, colon, and lower part of the small intestine). This test can confirm intestinal obstruction and Hirschsprung disease. The night before the test, you will drink a special liquid to flush out the bowel. A clean bowel is important, because even a small amount of stool in the colon can hide details and result in an incomplete exam.
During the same, the doctor fills the colon with barium, a chalky liquid that makes the area visible. Once the mixture coats the inside of the colon and rectum, x rays are taken that show their shape and condition. Abdominal cramping is normal as barium fills the colon. Stools may be white in color for a few days after the exam.
Colonoscopy - You receive medicine to help you sleep during a colonoscopy. During the exam, you lie on your side, and the doctor inserts the tube through the anus and rectum into the colon. The doctor then views the entire large intestine with a long, flexible tube with a camera attached to the end. If an abnormality is seen, the doctor can use the colonoscope to remove a small piece of tissue for examination (biopsy). You may feel gassy and bloated after this procedure.
Colorectal transit study - This test shows how well food moves through the colon. During a colorectal study, you swallow small capsules that can be seen on an x ray as they move through the large intestine and anus. The movement of the markers through the colon is monitored by abdominal x rays taken several times 3 to 7 days after the capsule is swallowed.
Defecography test - Defecography is an x ray of the anorectal area that evaluates completeness of stool elimination, identifies anorectal abnormalities, and evaluates rectal muscle contractions and relaxation. The doctor inserts a soft paste into the rectum. The doctor asks you to push out the paste while an x-ray machine takes pictures of the rectum and anus. The doctor then studies the x rays for anorectal problems that occurred as the paste was expelled.
Sigmoidoscopy - During a sigmoidoscopy, the doctor inserts a thin, flexible tube called a sigmoidoscope into the rectum after light sedation. This scope can show the last third of your large intestine. Doctors usually recommend a liquid dinner the night before a sigmoidoscopy and an enema early the next morning. An enema an hour before the test may also be necessary. The procedure may cause abdominal pressure and a mild sensation of wanting to move the bowels. The doctor may fill the colon with air to get a better view, which can cause mild cramping.
Constipation can be uncomfortable and lead to more serious complication. To start to learn more about relieiving constipation, read the next section on Treating Constipation now.
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