Strongyloides Does Not Typically Cause Long-Term Constipation
Strongyloides stercoralis infection is not characteristically associated with constipation; rather, it typically presents with diarrhea, abdominal bloating, and other gastrointestinal symptoms when symptomatic. 1
Typical Gastrointestinal Manifestations
The established clinical presentation of chronic strongyloidiasis includes:
- Diarrhea and abdominal bloating are the characteristic gastrointestinal symptoms, not constipation 1
- Abdominal pain is commonly reported in symptomatic infections 2, 3
- Most infections remain asymptomatic in immunocompetent hosts, with the majority of 30-100 million infected individuals having subclinical disease 4
- Larva currens (migratory urticarial rash) is actually the most common presentation overall 1
The Exception: Post-Surgical Residual Stomach
There is one documented case report where constipation was associated with S. stercoralis infection, but this occurred in a highly specific surgical context:
- A 47-year-old man with prior subtotal gastrectomy (Billroth type II) presented with nausea, vomiting, and constipation alongside S. stercoralis infection of the residual stomach 5
- This represents an atypical presentation in an anatomically altered gastrointestinal tract, not the natural course of strongyloidiasis 5
- The constipation resolved with albendazole treatment in this case 5
Severe Disease Presentations
In immunocompromised patients, the gastrointestinal manifestations differ markedly:
- Hyperinfection syndrome manifests as paralytic ileus, not simple constipation 1
- This occurs with massive parasite invasion in patients with defective granulocyte function, often associated with corticosteroid therapy, chemotherapy, malignancy, or HTLV-1 infection 1, 6
- Gastrointestinal bleeding, pneumonia, sepsis, and meningitis characterize severe disease 7
Clinical Pitfall
Do not attribute chronic constipation to strongyloidiasis without considering alternative diagnoses. If a patient from an endemic area presents with constipation and you suspect Strongyloides, look for the typical features:
- Eosinophilia (though may be absent in hyperinfection) 8, 9
- Larva currens rash 1, 7
- Diarrhea or abdominal bloating rather than constipation 1
- History of barefoot walking on contaminated soil 1
The evidence strongly supports that diarrhea, not constipation, is the hallmark bowel symptom of strongyloidiasis in typical presentations.