• Most of the times medical history gives a clue to the clinician if he is treating a case of occasional or chronic or pathological (with underlying cause) constipation. Painful passing of hard stools is usually associated with local conditions of anus (e.g. anal fissure, anal injury). Blood in the stools could be due to piles, fissure or cancer.
  • Local examination is done to visualize any abnormal finding of anus (malposition, smaller opening, occlusion of anal opening, prolapse) and of perianal region or the region around anal opening (presence of anal fissure, bleeding through anus, rash or local injury).
  • Digital rectal examination using gloved lubricated finger can evaluate the tone or any lesion inside anus. The presence of hard stools, tenderness or blood in the rectum is noted by the doctor.
  • Investigations need be undertaken in patients who have constipation with an underlying cause
    • Blood investigations help exclude general medical illnesses where constipation is one of the symptoms of illness e.g. hypothyroidism (where thyroid gland of the body functions suboptimally).
    • Radiological investigations like barium enema study helps in ruling out structural causes for constipation (as present in Hirschsprung’s disease). Physician might like to get X-ray of the spine in order to rule out abnormal innervation as the cause of constipation.
    • The information from above investigations can be supplemented with the results of endoscopic examination of rectum and sigmoid colon (proctoscopy, sigmoidoscopy or colonoscopy).


Investigations like colorectal transit study (movement of capsules with radiological markers swallowed orally is monitored along the gastrointestinal tract) and anorectal manometry need to be undertaken only in selected cases.