Infographic: Constipation

Author: Feng Peixue / Country: Mainland China
Publisher:
Publish Date: 2006-06-01
Features: Patients with constipation due to physical signs generally show no positive signs. Abdominal examination may reveal abdominal distension with gas, and in severe cases, dilated intestinal patterns can be observed. Many patients can palpatemasses in the left lower abdomen. Paying attention to the texture and relationship with defecation can differentiate between fecal impaction and tumors. In cases of pyloric obstruction, the upper abdomen is distended, with visible stomach patterns and reverse peristaltic waves. Mechanical obstruction often presents with intestinal peristaltic waves and increased bowel sounds. In cases of intestinal paralysis, bowel sounds disappear. Observe the anus and perianal area for hemorrhoids, anal fissures, and fistulas. Digital rectal examination should focus on whether there is rectal prolapse, anal fissure pain, anal canal stenosis, fecal impaction, or rectal prolapse into the vagina, which helps in diagnosing rectal cancer or impacted feces. In systemic diseases and neurological disorders, there are characteristic clinical findings.
Laboratory tests are necessary for further diagnosis, along with some special tests:
(1) Stool examination: In rectal constipation, the stool appears as hard, dark brown clumps. Due to secondary inflammation of the rectal mucosa or anal damage caused by defecation, the stool surface may show mucous blood. The stool shape may become thinner, which can be caused by anal sphincter spasm. If persistent stool thinning progresses, it should be considered as rectal cancer or other causes of rectal or anal stenosis. Hard, granular stool resembling sheep feces is characteristic of spasmodic constipation. In irritable bowel syndrome, the stool is not only sheep feces in shape but also often accompanied by a large amount of mucus. Mucus smear microscopy shows only a small number of white blood cells, which helps differentiate it from chronic bacterial dysentery and ulcerative colitis. Stool routine and occult blood tests are routine examinations.
(2) Digital rectal examination helps identify rectal cancer, rectal inflammation and stenosis, anal fissures, hemorrhoids, rectal hard fecal impaction, external pressure on the rectum, anal sphincter spasm or relaxation, and other causes of constipation. In elderly or frail patients with difficulty defecating, anal sphincter relaxation and rectal expansion filled with feces can be detected. P16