Differential Diagnosis for Constipation

Given the scenario where your wife has not passed her bowels in over 3 days, it's essential to consider various potential causes. Here's a categorized differential diagnosis:

• Single Most Likely Diagnosis

  • Constipation: This is the most straightforward diagnosis, given the symptoms. Constipation can be caused by a variety of factors including diet, lack of physical activity, medications, or underlying medical conditions. It's common and usually not immediately life-threatening but can cause significant discomfort.

• Other Likely Diagnoses

  • Bowel Obstruction: A partial or complete blockage of the bowel can prevent normal bowel movements. This could be due to adhesions from previous surgeries, hernias, or tumors.
  • Medication Side Effects: Certain medications, such as opioids, anticholinergics, and iron supplements, are known to cause constipation as a side effect.
  • Hypothyroidism: An underactive thyroid gland can slow down bowel movements, leading to constipation.
  • Neurological Disorders: Conditions like Parkinson's disease, multiple sclerosis, or spinal cord injuries can affect bowel function.

• Do Not Miss Diagnoses

  • Intestinal Ischemia: Reduced blood flow to the intestines can cause severe abdominal pain, constipation, and potentially lead to tissue death. This is a medical emergency.
  • Volvulus: A twisting of a portion of the intestine that can cut off blood flow and lead to tissue death, requiring immediate surgical intervention.
  • Appendicitis: Although more commonly associated with abdominal pain, in some cases, constipation can be an early symptom, especially if the appendix is located near the rectum.
  • Colorectal Cancer: While less common, new-onset constipation in older adults could be a symptom of colorectal cancer, especially if accompanied by other symptoms like weight loss or blood in the stool.

• Rare Diagnoses

  • Hirschsprung’s Disease: A congenital condition that affects the large intestine and causes problems with passing stool. It's typically diagnosed in infancy but can occasionally be diagnosed later in life.
  • Chronic Intestinal Pseudo-obstruction: A rare condition where there are symptoms of bowel obstruction without any physical blockage.
  • Amyloidosis: A condition caused by an abnormal protein (amyloid) that can accumulate in various organs, including the intestines, leading to constipation among other symptoms.

Given the acute presentation of not passing bowels for over 3 days, it would be prudent to seek medical evaluation to rule out the more serious causes, especially if accompanied by other symptoms like severe abdominal pain, vomiting, or fever. An emergency room visit might be warranted if there are signs of severe illness or if the constipation is accompanied by alarming symptoms.