Table 3

 Clues to the rarer causes of constipation and soiling

ConditionClueMinimal investigation
CRP, C reactive protein; ESR, erythrocyte sedimentation rate, IG, immunoglobulin; MRI, magnetic resonance imaging; TSH, thyroid stimulating hormone.
Coeliac diseaseWeight velocity worse than height velocityAnti-endomysial IgA antibodies as long as IgA concentrations normal
Crohn’s diseaseAbdominal pain and oral ulceration and deep anal fissuresCRP, ESR
Consider radioisotope WBC scan
Upper and lower gastrointestinal endoscopy and biopsy
Lichen sclerosis et atrophicusUsually girl with thickened perianal fissured skinDermatological opinion
HypothyroidismHeight velocity poorTSH and thyroid antibodies
Pelvic/spinal tumoursUrinary symptoms severeUltrasound and spinal MRI scan
Chronic intestinal pseudo-obstructionUpper gastrointestinal symptoms, reflux, failure to thriveElectrogastrograms/contrast meal