Name: Diagnosis of exclusion
Creator: Dr Karen Martin
Published: 2023-02-15T12:03:38.729Z

A doctor will make a diagnosis of exclusion based on a discussion of the symptoms, a thorough examination, and considering a patient’s medical history. They may do further tests to rule out other conditions before settling on a diagnosis. 

Next steps

Chronic pain is one of the toughest conditions to live with – either it’s unrelenting and making it impossible to get normal activities done, or it can come and go unpredictably, forcing you to cancel work or social plans. 

There are no clear figures as to how common chronic pain is but it may affect as many as one in three people. It's defined as persistent or episodic pain lasting more than three months and is a complex problem that isn’t just a simple physical one because it affects our mental health as well. As our nervous system adjusts to chronic pain, sensations become heightened and more widespread, and this complexity comes from our brain processing function, where pain can start to prevent everyday activities and dominate normal life. Our world becomes smaller and with less to distract us - and living in fear of pain - our pain sensation becomes even more heightened and worse. 

Chronic pain is more likely to come about from the slow pain fibers, which are loudly telling you that there’s injury: you should rest and recover by not moving much. This is opposed to the fast pain fibers that let you know your toe has been stubbed and makes you move away from the external threat (with much hopping and howling). But resting for months on end is not likely to serve any useful purpose, and often sets up new problems, both mentally and physically. 

We also now know there are two forms of chronic pain called primary chronic pain and secondary chronic pain. Chronic primary pain may affect around 1-6% of the population, and refers to the pain felt in conditions such as fibromyalgia, complex regional pain and chronic primary headache. Chronic secondary pain is more common and refers to pain from conditions such as low back pain, joint pain and shingles pain. 

A memory test gives a snapshot of different aspects of how you process and remember things.

There are different types of memory – think of recalling what you watched on TV last night (short-term memory) to reminiscing about a childhood holiday (long-term memory), or adding up your share of a restaurant bill (working memory). The memory test may assess other thinking or cognitive skills, such as abstract representation using shapes, language and communication skills, your concentration and attention skills, and general knowledge questions.

Some of the questions can seem quite basic or easy, and some seem confusing – just go with the flow. Great if you know the answer, and don't worry if you don't.

Abdominal pain (also known as stomach ache) is very common and has many causes. The majority of causes are not anything worrisome and improve on their own or with simple over-the-counter treatment. The most common causes are trapped gas, [indigestion](https://www.healthwords.ai/us/article/indigestion!98e618b1-88da-4f87-8745-39d5401529d6) or stomach irritation, and then [constipation](https://www.healthwords.ai/us/article/constipation!74479bdb-1aeb-4579-8dff-0a569bcacae6) or conditions that cause [diarrhea](https://www.healthwords.ai/us/symptom/diarrhea!bc5efd23-a024-4714-85a8-9a720a219c1d) such as food poisoning or even [irritable bowel syndrome](https://www.healthwords.ai/us/article/ibs-triggers-and-treatments-to-ease-your-symptoms!bd3ede6e-6898-4c83-82dd-badcb2a24b88). Abdominal pain can also be a normal part of many women’s menstruation symptoms.

There are a number of ways you can feel abdominal pain. It may be generalized, where you feel it in more than half of your tummy, and this is the sort of abdominal pain often felt with a stomach virus, indigestion or gas. It may also be localized to one part of your abdomen such as your appendix or stomach, or may feel like cramps.

Crampy pain isn’t usually serious but is often due to gas and [bloating](https://www.healthwords.ai/us/symptom/bloating!27859c7f-ea9d-43c3-92dd-23cbe1f10c4a). You can also get pain that feels like colic – waves of sharp pain that can stop and start suddenly and common causes of this abdominal pain are [kidney stones](https://www.healthwords.ai/us/article/kidney-stones!8a18d41a-e182-4a56-bf39-939b39e83467) and gallstones.

A stool test is done to assess the health of your bowel and your gut. It analyzes your poop as there are many things it can tell a doctor about your overall health.

Constipation: causes, symptoms & treatments

Constipation can happen to anyone from time to time. It's when you have to strain to open your bowels or have a bowel movement less often. This is usually less than three times a week, and stool can become hard and difficult to pass.  

Other symptoms include: 
- bloating 
- tummy pain  
- nausea 
- loss of appetite 

It's a very common problem and doesn't usually point to a serious cause, although certain health conditions make you more prone. You can take action yourself to address diet and activity levels or try some gentle medications to soften the stool and move it along.   

Constipation can feel uncomfortable and may cause complications such as: 
- hemorrhoids 
- anal fissures, which are small tears in the anus 
- fecal impaction, where hard, dry stool collects in the rectum 
- overflow diarrhea and possibly leakage 

It's important to address it early on before problems build up. We'll talk you through likely triggers, how to address them, and medications and remedies you can try to get things moving along.  

Fecal Immunochemical Test, or FIT, tests for microscopic traces of blood in your stool. It's a new and highly accurate test, and has two main purposes. The first is in [bowel cancer screening](https://www.healthwords.ai/us/article/bowel-cancer-screening!f898df6f-62c7-4ace-864e-151cfe3f4df6), where you have no symptoms, and the second is to diagnose a condition based on bowel symptoms, for example, in inflammatory bowel disease (IBD) like Crohn's disease or [ulcerative colitis](https://www.healthwords.ai/us/article/ulcerative-colitis!81899d8f-7e5f-43b7-89e8-5deb23bab014) (UC), or symptoms that could be [bowel cancer](https://www.healthwords.ai/us/article/bowel-cancer!e4349e54-12c5-4a08-abe3-079b3cf445d5). There can be lots of other causes for bleeding in the gut – some serious, some less so.

A positive test – that there is bleeding coming from somewhere in your gut – is used to then order further investigations that can pinpoint the cause of your symptoms, or determine whether this may be an early sign of bowel cancer.

It's important to emphasize that this is not a test for [cancer](https://www.healthwords.ai/us/article/cancer!48b81296-8811-48f8-95f1-4f693150bc2e) or any other disease – it only tests for blood in the gut, and this could also be from [hemorrhoids](https://www.healthwords.ai/us/article/hemorrhoids!165ae11c-18d9-4675-b6c5-5f4d22222967), a tear in the anus, a polyp, [diverticular disease](https://www.healthwords.ai/us/article/diverticulitis!7cb31e37-4faf-4f48-955c-3c0d9f9d1abe), or even bleeding from high up in the gut, like a [stomach ulcer](https://www.healthwords.ai/us/article/stomach-ulcer!522a14a1-a947-4bae-827e-eb9e69341251). It needs further investigations within context before a diagnosis can be made.

Ulcerative colitis is a condition where there is inflammation of the large bowel and rectum (the last part of the bowel where poop is stored). This inflammation can lead to severe problems, including bowel lining ulcers. Those suffering complaints of tummy pain and diarrhea often notice blood and mucus mixed in the stool.

Weight loss can occur as vital nutrients aren't absorbed, and the body puts its efforts into the inflammation process. You may also have a mild fever and feel fatigued, to the extent it's hard to get on with your daily tasks.

Symptoms can range from mild to severe, and there can be long periods of being symptom-free between flare-ups. How often you're opening your bowels can be a good marker of how bad the symptoms are. If you are emptying your bowels more than six times a day, this is a serious flare of symptoms.

Ulcerative colitis is a long-term condition that must be monitored and managed throughout your life. It is estimated that 1 million people in the US have ulcerative colitis and although it can develop at any age, it most commonly develops between the ages of 15 and 30. 

Someone is described as a hypochondriac when they experience anxieties about health, either in general or with specific illnesses. While we all have health anxieties, which can be useful to avoid injury or certain illnesses, the concerns of a hypochondriac are considered disproportionate to the threat. It can become all-consuming and have a significant impact on their everyday life.

Alzheimer’s disease is the most common form of [dementia](https://www.healthwords.ai/us/article/dementia!a751033a-4d1e-446b-9834-8879fb46a8d1) and mostly affects people over 65. It is believed to be caused by the build-up of abnormal proteins in the brain, reduced levels of neurological chemicals (neurotransmitters), and  shrinkage of different parts of the brain over time. This leads to problems with memory, language and performing tasks that the person had previously been able to do.

Dr Karen Martin

Pharmacist and Head of US Content

In medicine, we describe a condition as a diagnosis of exclusion when there’s no definitive test to prove it exists or that a particular person has it. Instead, we diagnose it as a collection of particular symptoms, while we’ve done tests to rule out other conditions that can cause a similar presentation. 

Irritable bowel syndrome is a good example – gut symptoms are very real to patients, but (as yet) we have no specific test. Instead, we rule out Crohn’s disease, ulcerative colitis, and celiac disease, which also cause gut symptoms. 

It’s also useful for conditions such as Alzheimer’s, where the clinical suspicion fits with what we know of the disease. A test is available, but it’s so invasive – requiring a sample of brain tissue – that it’s not an acceptable risk. So, we rule out other causes for memory loss, such as an infection or an electrolyte problem, and then diagnose Alzheimer’s based on the symptoms.

Diagnosis of exclusion

Next steps

Related topics

Chronic pain relief

What happens in a memory test?

Abdominal pain

What tests can be done on the stool?

Constipation: causes, symptoms & treatments

What's a FIT test?

Ulcerative colitis

Hypochondriac

Alzheimer's disease