scholarly journals Chronic constipation - the role of clinical assessment and colorectal physiologic tests to obtain an etiologic diagnosis

2008 ◽  
Vol 45 (1) ◽  
pp. 50-57 ◽  
Author(s):  
Antônio Lacerda-Filho ◽  
Marcílio José Rodrigues Lima ◽  
Marisa Fonseca Magalhães ◽  
Rodrigo de Almeida Paiva ◽  
José Renan da Cunha-Melo
Keyword(s):  
Irritable Bowel Syndrome ◽  
Differential Diagnosis ◽  
Pelvic Floor ◽  
Clinical Assessment ◽  
Chronic Constipation ◽  
Pelvic Floor Dysfunction ◽  
Fecal Impaction ◽  
Clinical Parameters ◽  
Irritable Bowel ◽  
Etiologic Diagnosis

BACKGROUND: Diagnosis of subtypes of chronic constipation has been considered difficult to achieve even in specialized centers. Although colorectal physiologic tests have brought an important contribution, it remains unclear in which patients these tests should be indicated for. AIMS: This study aims to establish a differential diagnosis for chronic constipation cases using clinical assessment and physiologic tests and to identify clinical parameters that could predict which patients need physiologic tests. METHODS: One hundred and seventy nine patients (83% females; mean age, 45) with chronic constipation according to Rome II criteria were initially treated by dietary advice and functional reeducation and those unresponsive (110 or 61.5%) were submitted to colonic transit time, defecography, anorectal manometry and electromyography, as needed. RESULTS: A differential diagnosis was achieved in 63.6% of patients tested. However, 61.5% of 179 patients with chronic constipation (69 with no need to tests and 40 with normal tests) have etiologic diagnosis established only on clinical basis. Irritable bowel syndrome (32%), pelvic floor dysfunction (29%) and functional constipation due to faulty diet and life style habits (22%) were the main causes of chronic constipation. Alternating constipation and nausea/vomiting were symptoms significantly related to the diagnosis of irritable bowel syndrome; younger age, larger intervals between bowel movements, occurrence of fecal impaction and necessity of enema were related to the diagnosis of non-chagasic megacolon and digital assistance to evacuate and large rectocele or spastic pelvic floor on rectal exam were associated to pelvic floor dysfunction. Patients with long-standing constipation, fecal impaction, abdominal pain not eased after defecation, necessity for enemas, digital assistance and evidence of rectocele tended to be in need for physiologic tests to define the cause of chronic constipation. CONCLUSIONS: The etiologic diagnosis of chronic constipation can be achieved in most of patients on a clinical basis and some symptoms may be significantly related to specific diagnoses. Indications for physiologic tests should be based on specific clinical parameters.

Constipation

2018 ◽  
Author(s):  
Satish Keshav ◽  
Alexandra Kent
Keyword(s):  
Irritable Bowel Syndrome ◽  
Pelvic Floor ◽  
Chronic Constipation ◽  
Secondary Care ◽  
Pelvic Floor Dysfunction ◽  
The Elderly ◽  
Normal Pattern ◽  
Normal Frequency ◽  
Slow Transit ◽  
Irritable Bowel

Patients and doctors often define constipation differently. The normal frequency of defaecation is once every 3 days to three times per day, and constipation may be defined as abnormally infrequent defaecation. A change in the normal pattern and frequency for the particular patient is pertinent. There are numerous causes of constipation, and most can be encountered in both primary and secondary care. In patients with chronic constipation without an evident cause, irritable bowel syndrome (IBS) is the cause in 59%, pelvic floor dysfunction in 25%, slow transit in 13%, and a combination of pelvic floor dysfunction and slow transit in 3%. Constipation affects twice as many women as men, with a higher prevalence in pregnant women. Prevalence is also greater in the elderly, affecting ~20% in the community.

Female Pelvic Pain: Assessment

2020 ◽  
Author(s):  
Mario Castellanos ◽  
Louise P King
Keyword(s):  
Irritable Bowel Syndrome ◽  
Pelvic Floor ◽  
Pelvic Pain ◽  
Chronic Pelvic Pain ◽  
Visceral Pain ◽  
Pelvic Floor Dysfunction ◽  
Pudendal Neuralgia ◽  
Somatic Pain ◽  
Irritable Bowel ◽  
Over Time

Chronic pelvic pain (CPP) in women is responsible for greater than 10% of referrals to gynecologists. A majority of them will remain undiagnosed or inadequately treated. Over time, CPP may lead to a syndrome that results in disability, loss of employment, and discord within relationships. This review discusses how to achieve a comprehensive assessment of CPP from a variety of causes. This review contains 13 figures, 5 tables and 60 references Key Words: dysmenorrhea, dyspareunia, endometriosis, interstitial cystitis, irritable bowel syndrome, pelvic floor dysfunction, pelvic pain, pudendal neuralgia, somatic pain, visceral pain

Female Pelvic Pain: Assessment

2018 ◽  
Author(s):  
Mario Castellanos ◽  
Louise P King
Keyword(s):  
Irritable Bowel Syndrome ◽  
Pelvic Floor ◽  
Pelvic Pain ◽  
Chronic Pelvic Pain ◽  
Visceral Pain ◽  
Pelvic Floor Dysfunction ◽  
Pudendal Neuralgia ◽  
Somatic Pain ◽  
Irritable Bowel ◽  
Over Time

Chronic pelvic pain (CPP) in women is responsible for greater than 10% of referrals to gynecologists. A majority of them will remain undiagnosed or inadequately treated. Over time, CPP may lead to a syndrome that results in disability, loss of employment, and discord within relationships. This review discusses how to achieve a comprehensive assessment of CPP from a variety of causes. This review contains 12 figures, 2 tables and 57 references Key Words: dysmenorrhea, dyspareunia, endometriosis, interstitial cystitis, irritable bowel syndrome, pelvic floor dysfunction, pelvic pain, pudendal neuralgia, somatic pain, visceral pain

Irritable Bowel Syndrome with Constipation

2015 ◽  
Author(s):  
Loni Tang ◽  
Brooks D. Cash
Keyword(s):  
Irritable Bowel Syndrome ◽  
Differential Diagnosis ◽  
Abdominal Pain ◽  
Digital Rectal Examination ◽  
Recurrent Abdominal Pain ◽  
Differential Diagnoses ◽  
Rectal Examination ◽  
Stool Form ◽  
Alarm Features ◽  
Irritable Bowel

Irritable bowel syndrome (IBS) is characterized by recurrent abdominal pain or discomfort that has occurred at least 3 days per month in the 3 months prior to diagnosis. One of the subtypes of this disorder is IBS with constipation (IBS-C), where individuals experience hard or lumpy stools at least 25% of the time and loose or watery stools less than 25% of the time with defecation. This review addresses IBS-C, detailing the epidemiology, etiology, pathophysiology and pathogenesis, diagnosis, differential diagnosis, treatment, and prognosis. A figure shows the Bristol stool form scale. Tables list IBS subtypes, components of digital rectal examination, differential diagnoses for IBS and IBS-C, alarm features, and the American College of Gastroenterology Recommendations. This review contains 1 highly rendered figure, 6 tables, and 71 references. 

Irritable bowel syndrome and lactose intolerance: the importance of differential diagnosis. A monocentric study

2021 ◽  
Vol 67 (1) ◽  
Author(s):  
Roberto CATANZARO ◽  
Morena SCIUTO ◽  
Birbal SINGH ◽  
Surajit PATHAK ◽  
Francesco MAROTTA
Keyword(s):  
Irritable Bowel Syndrome ◽  
Differential Diagnosis ◽  
Lactose Intolerance ◽  
Irritable Bowel

scholarly journals Rational Use of Fecal Calprotectin in Irritable Bowel Syndrome and Inflammatory Bowel Disease

2021 ◽  
Author(s):  
Roberto Catanzaro ◽  
Alfio Maugeri ◽  
Morena Sciuto ◽  
Fang He ◽  
Baskar Balakrishnan ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Irritable Bowel Syndrome ◽  
Differential Diagnosis ◽  
Bowel Disease ◽  
Intestinal Inflammation ◽  
Gastrointestinal Disorder ◽  
Fecal Calprotectin ◽  
Mean Values ◽  
Inflammatory Bowel ◽  
Irritable Bowel

The gastrointestinal pathologies have increased over the last years. The clinical pictures of inflammatory and irritable bowel disease might overlap, leading to expensive and invasive tests. Our study aims to investigate fecal calprotectin as an effective tool for differential diagnosis of gastrointestinal disorders. Two hundred fifty-six patients with the diagnosis of the gastrointestinal disorder and subjected to colonoscopy were collected for the statistical analysis of fecal calprotectin. The differential diagnosis of intestinal inflammation or non-inflammation was performed according to the Receiver Operating Characteristic (ROC) curve that outlines the Area Under Curve (AUC), Sensitivity (Se), Specificity (Sp). Fecal calprotectin was significantly elevated in patients with inflammatory bowel disease compared with patients with irritable bowel syndrome. Especially, the mean values of fecal calprotectin were 522 g/g (IQR=215-975) and 21 g/g (IQR=14-34.5) in patients with and without inflammation, respectively (P<0.0001). AUC value of fecal calprotectin was 0.958 (Se=88.9%, Sp=91.1%, with a cut-off value of 50 g/g) for differentiating between inflammatory bowel disease and irritable bowel syndrome. Fecal calprotectin seems to be a non-invasive and inexpensive biomarker useful for the purpose of a differential diagnosis between inflammatory bowel disease and irritable bowel syndrome.

Sign in / Sign up

Export Citation Format

Share Document