The vast majority of causes of chronic constipation are functional, such as idiopathic, and irritable bowel syndrome, which makes evaluating a patient with constipation relatively easy for a clinician. However, defining constipation is a challenge as no consensus exists on a common definition. Most authorities recommend that if a patient complains about constipation, a clinician must assume that the problem exists and fully evaluate the problem. Probable diagnoses are listed in the order of prevalence. In addition to functional causes, a clinician must explore several metabolic and structural causes.
Urgent/emergent situations include scenarios where advanced pathology exists and the patient is visibly uncomfortable, has vomiting and/or has abnormal vital signs due to underlying disease processes. A few disease conditions, such as severe metabolic disorders, drug toxicity, advanced malignancy, and structural adhesions, can give rise to urgent/emergent situations.
Weighing and removing anchor bias involves a clinician taking a complete history, differentiating between functional, metabolic, toxic and structural causes, performing a physical exam, and ordering appropriate labs/tests. High yield questions include first establishing the duration, pattern, and type of constipation. The duration of symptoms helps a clinician decide if the condition is acute or chronic. The pattern of bowel movements and the amount of fiber intake (especially in the case of chronic constipation) help a clinician differentiate between functional and non-functional causes. A clinician must ask additional medium yield questions, which are listed on the clinical mind map. Specific labs/tests that are listed on the clinical mind map can further help a clinician narrow the differential diagnosis.