Constipation: Or something else? Differential Diagnosis

Congenital malformations, deformities, and chromosomal abnormalities (Q00-Q99).

  • Hirschsprung’s disease (MH; synonym: megacolon congenitum) – genetic disorder with both autosomal recessive inheritance and sporadic occurrence; disorder that in most cases is affects the last third of the colon (sigmoid and rectum) of the large intestine; belongs to the group of aganglionoses; lack of ganglion cells (“aganglionosis”) in the submucosal plexus or myentericus (Auerbach’s plexus) leads to hyperplasia of the upstream nerve cells, resulting in increased acetylcholine release. The permanent stimulation of the ring muscles thus leads to a permanent contraction of the affected section of the intestine.MH is relatively common at 1: 3,000 – 1: 5,000 births, boys are affected up to four times more often than girls. [paradoxical diarrhea/diarrhea; diarrhea alternating with constipation/constipation.]
  • Neurofibromatosis – genetic disease with autosomal dominant inheritance; belongs to the phakomatoses (diseases of the skin and nervous system); three genetically different forms are distinguished:
    • Neurofibromatosis type 1 (von Recklinghausen’s disease) – patients develop multiple neurofibromas (nerve tumors) during puberty, often occurring in the skin but also occurring in the nervous system, orbita (eye socket), gastrointestinal tract (gastrointestinal tract), and retroperitoneum (space located behind the peritoneum on the back toward the spine); The appearance of café-au-lait spots (CALF; light brown macules) and multiple benign (benign) neoplasms is typical
    • [Neurofibromatosis type 2 – characterized by bilateral (bilateral) acoustic neuroma (vestibular schwannoma) and multiple meningiomas (meningeal tumors).
    • Schwannomatosis – hereditary tumor syndrome]

Endocrine, nutritional and metabolic diseases (E00-E90).

  • Amyloidosis – extracellular (“outside the cell”) deposits of amyloids (degradation-resistant proteins) that can lead to cardiomyopathy (heart muscle disease), neuropathy (peripheral nervous system disease), and hepatomegaly (liver enlargement), among other conditions.
  • Conn syndrome (primary hyperaldosteronism, PH).
  • Diabetes mellitus
  • Hashimoto’s thyroiditis – autoimmune disease leading to chronic thyroiditis.
  • Hypercalcemia (excess calcium).
  • Hyperparathyroidism (parathyroid hyperfunction).
  • Hypokalemia (potassium deficiency)
  • Hypothyroidism (hypothyroidism)
  • Cystic Fibrosis (ZF) – genetic disease with autosomal recessive inheritance characterized by the production of secretions in various organs to be tamed.
  • Porphyrias – group of hereditary metabolic diseases associated with a disorder of the structure of the red blood pigment heme.
  • Rickets – refers to a disorder of bone metabolism in children, resulting in marked demineralization of bone and skeletal changes due to retardation of bone growth. In adults with completed bone growth, the symptomatology is called osteomalacia.

Cardiovascular system (I00-I99).

Infectious and parasitic diseases (A00-B99).

  • Chagas disease – South American infectious disease caused by unicellular parasites.
  • Helminthiasis – diseases caused by parasitic worms.
  • Syphilis (lues) – venereal disease
  • Typhoid abdominalis – infectious disease caused by the serovar Typhi of the bacterial species Salmonella enterica.

Liver, gallbladder and bile ducts – pancreas (pancreas) (K70-K77; K80-K87).

  • Biliary colic
  • Pancreatitis (inflammation of the pancreas)

Mouth, esophagus (esophagus), stomach, and intestines (K00-K67; K90-K93).

  • Anal fissure – tears in the mucosa of the anus (anus).
  • Anal stricture – narrowing of the anus.
  • Anorectal voiding disorders such as:
    • Intussusception (synonym: intussusception) – invagination of a portion of the bowel into itself or a neighboring organ.
    • Pelvic floor depression
    • Enterocele – hernia of the intestine that protrudes into the vagina.
    • Reflector-induced defecation disorders.
    • Rectocele – outpouching of the anterior wall of the rectum into the vagina.
  • Abdominal wall hernia (hernia of the intestine)
  • Intestinal ischemia – circulatory disorders of the intestine.
  • Intestinal tuberculosis [paradoxical diarrhea; diarrhea alternating with constipation/constipation]
  • Diverticulitis – inflammation of the wall of the diverticulum.
  • Diverticulosis – change in the colon in the form of small protrusions of the intestinal wall (diverticula).
  • Dysbiosis – disease process triggered by a qualitatively and / or quantitatively deviating from the norm bacterial flora in the intestine.
  • Hemorrhoids
  • Ileus (intestinal obstruction)
  • Colonic transit disorder – prolonged retention of stool in the colon.
  • Periproctitic abscess – encapsulated purulent inflammation in the area of the anal canal.
  • Peritonitis (inflammation of the peritoneum)
  • Irritable bowel syndrome (irritable colon)
  • Rectocele – is a protrusion of the anterior wall of the rectum into the vagina due to weakness of the wall layers between the rectum and the vagina.
  • Rectal prolapse (rectal prolapse), also known as anal prolapse.

Musculoskeletal system and connective tissue (M00-M99).

  • Muscle diseases, unspecified
  • Myopathies (muscle diseases):
    • Atrophic desmosis coli
    • Degenerative fibrosis
    • Enteric leiomyositis, amphophilic inclusion bodies.
    • Myofilament loss
  • Progressive systemic sclerosis – severe generalized disease manifesting in many organs.

Neoplasms – tumor diseases (C00-D48).

  • Familial adenomatous polyposis – autosomal dominant inherited disorder in which there is a mass infestation of the colon (large intestine) with polyps [paradoxical diarrhea; diarrhea alternating with constipation/constipation].
  • Colon carcinoma (colon cancer) [paradoxical diarrhea/diarrhea; diarrhea alternating with constipation/constipation]
  • Colonic polyps – tissue protrusions into the cavity of the colon.
  • Neuroblastoma – malignant neoplasm of the autonomic nervous system.
  • Ovarian carcinoma (ovarian cancer)
  • Peritoneal carcinomatosis – extensive infestation of the peritoneum (peritoneum) with malignant tumor cells.
  • Pheochromocytoma – usually benign (benign) tumor (about 90% of cases), which originates predominantly from the adrenal gland and can lead to hypertensive crisis (hypertensive crisis).
  • Rectal carcinoma (rectal cancer).
  • Tumors in the central nervous system

Psyche – nervous system (F00-F99; G00-G99)

  • Anxiety
  • Dementia
  • Depression
  • Diabetic polyneuropathy – damage to multiple nerves (polyneuropathy) that occurs as a complication of existing diabetes mellitus.
  • Drug abuse
  • Eating disorders
  • Guillain-Barré polyneuritis (synonyms: acute inflammatory demyelinating polyneuropathy; chronic inflammatory demyelinating polyneuropathy; idiopathic polyradiculoneuritis; Landry-Guillain-Barré-Strohl syndrome,) – idiopathic polyneuritis (inflammatory disease of multiple nerves) of spinal nerve roots and peripheral nerves.
  • Parkinson’s disease
  • Multiple sclerosis (MS) – chronic inflammatory demyelinating disease of the central nervous system (CNS) that can cause paralysis and spasticity.
  • Neuropathies (diseases of the peripheral nervous system):
    • Degenerative neuropathy
    • Enteric ganglionitis
    • Hypoganglionosis of the myenteric plexus
    • Intestinal neuronal dysplasia

Symptoms and abnormal clinical and laboratory findings not elsewhere classified (R00-R99).

  • Uremia (occurrence of urinary substances in the blood above normal levels).

Genitourinary system (kidneys, urinary tract – reproductive organs) (N00-N99).

  • Adnexitis
  • Descensus (lowering of the pelvic floor)
  • Genital prolapse – partial or complete prolapse of the vagina (descensus vaginae) and / or uterus (descensus uteri) from the pubic cleft (rima pudendi).
  • Nephrolithiasis (kidney stones).
  • Renal colic
  • Premenstrual syndrome (PMS) – occurs in women about four to fourteen days before their next period and involves a complex picture of different symptoms and complaints

Injury, poisoning, and other sequelae of external causes (S00-T98).

  • Pseudoallergy (pseudoallergic/nonimmunologic reaction).
  • Stricture (high-grade narrowing) of the intestine after surgery/radiatio (radiation therapy).
  • Injury to the spinal cord – spinal cord cross-section, lesion of vegetative nerve plexuses (pelvic surgery).

Medication

  • See “Causes” under medications

Environmental pollution – intoxication (poisoning).

  • Lead

Other differential diagnoses

  • Change of location (travel obstipation)
  • Pregnancy (3rd trimester/third trimester).
  • Cycle (2nd half of the cycle)