Laboratory Tests to Identify Secondary Causes

• Thyroid function tests; abnormal thyroid hormone levels may suggest hypothyroidism, which may be associated with constipation.

• Serum calcium; either increased or decreased serum calcium levels may be associated with constipation.

• Glucose; increased blood glucose may indicate diabetes mellitus, which may be associated with constipation.

• Serum electrolytes; dehydration may be associated with constipation.

• Urinalysis may also indicate dehydration, if present.

• Complete blood count; anemia may be due to cancer or another systemic disorder accompanied by constipation.

Dietary habits should be evaluated; patients should be encouraged to maintain adequate fiber intake and hydration. Evaluation of psychosocial status is recommended. Constipation may occur in patients who are depressed or in psychosocial distress. A complete family history should be obtained, particularly as it relates to inflammatory bowel disease and colon cancer. A full record of prescription and over-the-counter medications is mandatory to identify drug-related causes of constipation.

In most cases, there is no underlying cause of constipation, and the physical examination and rectal examination are normal. Endoscopic evaluation is required in patients who have weight loss, rectal bleeding, or anemia with constipation. These examinations can be used to exclude the presence of cancer or strictures, especially in patients over the age of 50 years. Endoscopic evaluation is appropriate in patients without alarm symptoms and those younger than 50 years of age. However, all adults older than 50 years of age who present with new-onset constipation should undergo endoscopic evaluation to rule out malignancy.7

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