CKS is no longer commissioned by the National Institute for Health and Clinical Excellence (NICE). NICE remains committed to providing a replacement service for CKS and is currently reviewing its options. In the meantime, although CKS content is now not being maintained, it still remains relevant and will continue to be made available. CKS content was generated under a programme of topic creation and update. To check if the topic you are viewing is current or out of date, please refer to the topic publication details by clicking on the 'How up-to-date is this topic?' link in the left hand menu on individual topic pages.
Palliative cancer care - constipation - Making a diagnosis
How do I know my patient has it?
- Constipation is diagnosed when defecation is unsatisfactory because of infrequent stools, difficult stool passage, or seemingly incomplete defecation.
- Other symptoms of constipation include malaise; flatulence, abdominal pain and distension; anorexia, nausea, or vomiting; halitosis; and faecal incontinence (overflow diarrhoea).
- Constipation can be a source of considerable distress and may cause or worsen delirium, particularly in the elderly or people with impaired brain function (e.g. dementia).
- Faecal loading/impaction is diagnosed:
- On history. The person reports:
- Passing hard, lumpy stools, which are either large and infrequent (e.g. every 7–10 days), or small and relatively frequent (e.g. every 2–3 days).
- Having to use manual methods to extract faeces.
- Overflow faecal incontinence, or loose stools.
- On examination:
- Faecal masses are palpable abdominally or peri-anally, or on internal rectal examination.
- Faecal loading/constipation can be confirmed by plain abdominal X-ray.
[Fallon and O'Neill, 1998; Regnard et al, 2004; Sykes, 2004]
© NHS Institute for Innovation and Improvement