title: [Guidelines for diagnosis and treatment of constipation in Mexico. B) Diagnostic approach].
abstract: BACKGROUND
  Constipation is a heterogeneous symptom so an accurate diagnosis requires an appropriate approach.
  
  
  OBJECTIVE
  To establish the clinical guidelines for diagnosis and treatment of chronic constipation in Mexico we have reviewed the diagnostic aspects of constipation according to the availability of resources in our country. In addition, evidence-based recommendations have been provided.
  
  
  RESULTS
  The symptoms that best define constipation in our population are infrequent stool, hard stool expulsion, excessive effort and sensation of incomplete evacuation. Digital rectal examination is a useful diagnostic tool to discard organic diseases and pelvic floor dyssynergia. Patients with risk factors such as recent onset of constipation, family history of inflammatory bowel disease or colon cancer and those with alarm signs (unintentional weight loss and significant anemia, blood in stool) should undergo endoscopic diagnostic studies. If they are available, the most useful tests in evaluating patients with functional constipation are colonic transit with radiopaque markers and anorectal manometry with balloon expulsion test.
  
  
  CONCLUSIONS
  Patients with symptoms of chronic constipation should undergo advanced colorectal physiological studies to try to establish the cause of constipation.
authors: Laboratorio de Fisiología Digestiva, Instituto de Investigaciones Medico Biológicas, Universidad Veracruzana, México. jose.remes.troche@gmail.com
authors: José María
authors: JM
authors: Remes Troche
authors: Ramón
authors: R
authors: Carmona Sánchez
authors: María Teresa
authors: MT
authors: Abreu y Abreu
authors: María Eugenia
authors: ME
authors: Icaza Chávez
authors: Marina Alejandra
authors: MA
authors: González Martínez
authors: Miguel Ángel
authors: MÁ
authors: Valdovinos Díaz
mesh_terms: D002908:Chronic Disease; D003248:Constipation / Q000175:diagnosis* / Q000209:etiology; D003672:Defecation; D051517:Digital Rectal Examination; D019317:Evidence-Based Medicine; D005243:Feces; D006801:Humans; D008800:Mexico; D059952:Pelvic Floor Disorders / Q000150:complications