Clues to the rarer causes of constipation and soiling
| Condition | Clue | Minimal investigation |
|---|---|---|
| CRP, C reactive protein; ESR, erythrocyte sedimentation rate, IG, immunoglobulin; MRI, magnetic resonance imaging; TSH, thyroid stimulating hormone. | ||
| Coeliac disease | Weight velocity worse than height velocity | Anti-endomysial IgA antibodies as long as IgA concentrations normal |
| Crohn’s disease | Abdominal pain and oral ulceration and deep anal fissures | CRP, ESR |
| Consider radioisotope WBC scan | ||
| Upper and lower gastrointestinal endoscopy and biopsy | ||
| Lichen sclerosis et atrophicus | Usually girl with thickened perianal fissured skin | Dermatological opinion |
| Hypothyroidism | Height velocity poor | TSH and thyroid antibodies |
| Pelvic/spinal tumours | Urinary symptoms severe | Ultrasound and spinal MRI scan |
| Chronic intestinal pseudo-obstruction | Upper gastrointestinal symptoms, reflux, failure to thrive | Electrogastrograms/contrast meal |