Differential Diagnosis for Incontinence of Bowels, Diarrhea, and Negative Occult Blood
Single Most Likely Diagnosis
- Gastroenteritis: This is the most likely diagnosis due to the symptoms of incontinence of bowels and diarrhea, which are common presentations of viral or bacterial gastroenteritis. The absence of occult blood and recent medication changes or trauma also supports this diagnosis.
Other Likely Diagnoses
- Irritable Bowel Syndrome (IBS): IBS can cause chronic diarrhea and bowel incontinence, especially if the patient has a history of abdominal pain, bloating, or changes in bowel habits.
- Inflammatory Bowel Disease (IBD): Although less likely without occult blood, IBD (e.g., Crohn's disease, ulcerative colitis) can cause diarrhea and bowel incontinence, especially if the disease is not well-controlled.
- Food Poisoning: Food poisoning can cause acute diarrhea and bowel incontinence, often with a recent history of consuming contaminated food or water.
Do Not Miss Diagnoses
- Clostridioides difficile (C. diff) Infection: Although the patient reports no recent medication changes, C. diff infection can still occur and cause severe diarrhea and bowel incontinence. Missing this diagnosis can lead to severe complications, including sepsis and death.
- Intestinal Ischemia: This is a rare but life-threatening condition that can cause acute diarrhea and bowel incontinence. It is essential to consider this diagnosis, especially in older adults or those with a history of vascular disease.
- Neurogenic Bowel: A neurologic condition, such as spinal cord injury or multiple sclerosis, can cause bowel incontinence and diarrhea. Missing this diagnosis can lead to significant morbidity and mortality.
Rare Diagnoses
- Whipple's Disease: A rare, systemic bacterial infection that can cause chronic diarrhea, weight loss, and abdominal pain.
- Short Bowel Syndrome: A condition that occurs after a significant portion of the small intestine is removed, leading to chronic diarrhea and malabsorption.
- Amyloidosis: A rare condition that can cause chronic diarrhea and bowel incontinence due to the deposition of abnormal proteins in the intestinal wall.