symptoms of digestive disorders
digestive disorders
Constipation in Adults
Not every episode of constipation requires immediate evaluation by a doctor. The following information can help people decide whether a doctor’s evaluation is needed and help them know what to expect during the evaluation. In people with constipation, certain symptoms and characteristics are cause for concern. They include Distended, swollen abdomen Vomiting Blood in stool Weight loss New/worsening severe constipation in older people People who have warning signs should see a doctor right away, unless the only warning signs are weight loss and/or new constipation in older people. In such cases, a delay of a few days to a week is not harmful. People who have constipation but no warning signs should call their doctor, who can help decide how quickly they need to be seen. Depending on the person's other symptoms and known disorders, doctors may wish to see the person within a few days or may simply recommend trying changes in diet and/or a mild laxative. Doctors first ask questions about the person's symptoms and medical history. Doctors then do a physical examination. What they find during the history and physical examination often suggests a cause of the constipation and the tests that may need to be done ( see Table: Some Causes and Features of Constipation ). During the history, doctors ask about the following: Stool frequency, consistency, and the need to strain or use maneuvers (such as pushing on the area between the scrotum or vagina and the anus [perineum] during defecation) Feeling of incomplete evacuation Satisfaction after defecation, including how often and how long people have used laxatives or enemas Diet and physical activity level, particularly any change in these factors Prescription and nonprescription drug use (particularly those known to cause constipation) Doctors also ask about symptoms of metabolic (such as hypothyroidism and diabetes) and neurologic (such as spinal cord injury) disorders. During the physical examination, doctors look at the following: Signs of bodywide (systemic) disease, including weight loss, fever, and severe wasting away of muscle and fat tissue (cachexia) The abdomen for distention and masses The rectum for fissures, hemorrhoids, blood, or masses (including fecal impaction) and also anal muscle tone and sensation The need for tests depends on what doctors find during the history and physical examination, particularly whether warning signs are present. When the cause of the constipation is clear (such as due to drugs, injury, or bed rest), doctors often treat the person’s symptoms and do no testing. People with symptoms of intestinal obstruction undergo abdominal x-rays and possibly a Computed Tomography (CT) . Most people with no clear cause or whose symptoms have not been relieved with treatment should have tests. Typically, doctors do a People whose initial test results are normal but whose symptoms are not relieved with treatment usually require further testing. If the main symptom is difficulty with defecation, doctors measure the pressure inside the anus and rectum (called anorectal manometry). If the main symptom is infrequent defecation, doctors measure how long it takes stool to leave the intestines by having people swallow small, slightly radioactive objects that can be tracked using a scanner (a type of Radionuclide Scanning ) or swallow a wireless motility capsule that is tracked over a 4-day period. 