DigitalCommons@PCOM

Hidden constipation presenting as diarrhea

Suwanee, GA

Introduction: Diarrhea and constipation are two of the most common gastrointestinal symptoms presenting in both inpatient and outpatient settings. Diarrhea presents as loose, watery stool often with increased frequency while constipation often presents as hard stool, decreased frequency, and increased straining. In a subset of patients that suffer from constipation, liquid stool from more proximal colonic segments may bypass impacted feces and result in diarrhea, thus creating a confusing clinical picture and potentially misleading treatment plan. Objectives: Our objective is to redefine IBSD with a new subset of patients with IBSD who have hidden constipation. This study could help open up new pathways for therapy and greatly increase the quality of life of many patients. In our proposed study, we hope to look further into the relationship between patients suffering from constipation and its subsequent presentation as diarrhea. Methods: In this retrospective study we plan to radiographically analyze the stool burden of patients presenting with non-infectious diarrhea. We aim to assess the frequency of hidden constipation in patients presenting with diarrhea in the office of GI Consultants. The date ranges from January 2017 to present. Hidden constipation was assessed based on obstruction series or CT imaging. After ruling out other etiologies of diarrhea, such as bile acid associated diarrhea (BAD) or colitis, and, depending on the response, other workups, such as obstruction series and colonoscopies, were analyzed. Critical to our study will be the ruling out of any other potential cause of diarrhea, such as medications and previously mentioned infection. Once other causes are ruled out, focus can be given to the obstruction series for signs of constipation. Evidence of constipation on plain abdominal radiograph will show dilated loops of bowel with fecal material retained in areas of the large intestine. By documenting the areas of stool burden as seen on the obstruction study as ascending, transverse, or descending colon, we will begin to understand the prevalence and presentation of hidden constipation that presents paradoxically as diarrhea. Results: Of the 51 patients presenting with non-infectious, non-bloody diarrhea, 19.61% (n=10), presented with hidden constipation. Other significant presentations were bile acid diarrhea (19.61%), Irritable Bowel Syndrome (9.80%), and colitis (9.80%). 21.57% were unknown or lost to follow-up (n=11). Of the patients that did receive an obstruction series (n=12), 10 patients showed abnormal stool burden. Conclusion: This is a small retrospective study focusing on patients presenting to an outpatient setting with non-infectious, non-bloody diarrhea. Preliminary data has shown that with proper clinical suspicion, an obstruction series may be effective in showing hidden constipation in the setting of diarrhea. Further research may be necessary to show if laxative treatment of hidden constipation will be efficacious in treatment of hidden constipation associated diarrhea.