https://wikem.org/w/index.php?action=history&feed=atom&title=Constipation%2FenConstipation/en - Revision history2026-04-18T10:19:10ZRevision history for this page on the wikiMediaWiki 1.38.2https://wikem.org/w/index.php?title=Constipation/en&diff=381835&oldid=prevFuzzyBot: Updating to match new version of source page2026-01-14T12:57:48Z<p>Updating to match new version of source page</p>
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''This page is for '''adult''' patients; for pediatric patients see [[Special:MyLanguage/constipation (peds)|constipation (peds)]].''<br />
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==Background==<br />
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[[File:Diameters of the large intestine.png|thumb|Normal inner diameters of colon sections.]]<br />
[[File:Rectum anatomy en.png|thumb|Anatomy of the anus and rectum.]]<br />
*Acute constipation is intestinal obstruction until proven otherwise <br />
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===Red flags===<br />
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*Weight loss <br />
*[[Special:MyLanguage/Rectal bleeding|Rectal bleeding]]/melena <br />
*[[Special:MyLanguage/Nausea/vomiting|Nausea/vomiting]]<br />
*[[Special:MyLanguage/Fever|Fever]] <br />
*Rectal pain <br />
*Change in stool caliber<br />
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==Clinical Features==<br />
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[[File:BristolStoolChart.png|thumb|Bristol Stool Chart.]]<br />
*Decreased frequency of bowel movements<br />
*Hard, dry, and/or difficult to pass stool<br />
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==Differential Diagnosis==<br />
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{{Constipation DDX}}<br />
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{{Anorectal DDX}}<br />
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{{DDX abdominal distention}}<br />
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==Evaluation==<br />
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===Work up===<br />
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*Digital rectal exam<br />
*Abdominal panel<br />
**CBC<br />
**Chemistry ([[Special:MyLanguage/hypokalemia|hypokalemia]] or [[Special:MyLanguage/hypercalcemia|hypercalcemia]]) <br />
**LFTs + lipase<br />
**Consider coagulation studies (PT, PTT, INR), as a marker of liver function<br />
*Consider [[Special:MyLanguage/TSH|TSH]] if concern for [[Special:MyLanguage/hypothyroid|hypothyroid]] related [[Special:MyLanguage/constipation|constipation]]<br />
*Consider [[Special:MyLanguage/lactate|lactate]] if concern for [[Special:MyLanguage/stercoral colitis|stercoral colitis]]<br />
*CT if abdominal tenderness, elderly, or severe presentation<br />
**'''Constipation should not cause abdominal tenderness on exam'''<br />
**CT may show stool burden in colon/rectum<br />
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===Diagnosis===<br />
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*Diagnosis is frequently clinical<br />
*In patients with concerning symptoms/risk factors, CT can confirm diagnosis and rule out more emergent conditions<br />
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==Management==<br />
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*Adequate fluid (1.5L per day)<br />
*Fiber (10gm per day)<br />
**Bran: 1 cup daily <br />
**[[Special:MyLanguage/Psyllium|Psyllium]] (Metamucil): 1-2 teaspoon TID <br />
*Exercise <br />
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===Medication options===<br />
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*Emollient <br />
**[[Special:MyLanguage/Docusate|Docusate]] (Colace): 100mg QD-BID (facilitates mixture of stool fat and water) <br />
**Mineral oil (long term use causes malabsorption)<br />
*Stimulants <br />
**[[Special:MyLanguage/Bisacodyl|Bisacodyl]] (Dulcolax): 10mg PR TID <br />
**[[Special:MyLanguage/Senna|Senna]]: Two tab PO QD-BID <br />
*Saline laxative <br />
**Milk of mangesia: 15-30 mL QD-BID <br />
**Magnesium citrate: 100-240 mL QD-BID <br />
*Hyperosmolar agents <br />
**[[Special:MyLanguage/Lactulose|Lactulose]] 15-30 mL QD-BID <br />
**[[Special:MyLanguage/Polyethylene glycol 3350|PEG]]: 1 gallon/4h <br />
**[[Special:MyLanguage/Polyethylene glycol 3350|PEG]](Miralax): 17gm<br />
**Glycerin: 1 adult suppository PR, onset of action 15-30 min, then 1-2 doses per day<br />
*Enemas<br />
**Soap suds, saline, tap water enema (rectal distention, causing evacuation)<ref>Portalatin M and Winstead N. Medical Management of Constipation. Clin Colon Rectal Surg. 2012 Mar; 25(1): 12–19.</ref><br />
**May add 50-100 mg of docusate liquid to saline or water enema<br />
**Fleet Phospho-soda: 118 ml single enema dose, with maximum of x2 doses at least 1 hr apart<br />
***No more than 2 doses in a 24 hr period may be administered without serum phos, mag, calcium levels<ref>Farah R. Fatal acute sodium phosphate enemas intoxication. Acta Gastroenterol Belg. 2005 Jul-Sep;68(3):392-3.</ref><br />
***May observe [[Special:MyLanguage/hyperphosphatemia|hyperphosphatemia]], [[Special:MyLanguage/hypocalcemia|hypocalcemia]], [[Special:MyLanguage/hypomagnesemia|hypomagnesemia]]<br />
***High risk patients: renal impairement, abnormal gut motility, [[Special:MyLanguage/IBD|IBD]], elderly, cardiac co-morbidities<ref>Reedy JC, Zwiren GT. Enema-induced hypocalcemia and hyperphosphatemia leading to cardiac arrest during induction of anesthesia in an outpatient surgery center. Anesthesiology. 1983 Dec;59(6):578-9.</ref><ref>Korzets A, Dicker D, Chaimoff C, Zevin D. Life-threatening hyperphosphatemia and hypocalcemic tetany following the use of fleet enemas. J Am Geriatr Soc. 1992 Jun;40(6):620-1.</ref><br />
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====Gastrografin PO====<br />
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*Gastrografin through NG or OG decreases bowel wall edema and increases bowel motility<ref>Assalia A, Schein M, Kopelman D, et al. Therapeutic effect of oral Gastrografin in adhesive, partial small-bowel obstruction: A prospective randomized trial. Surgery 1994; 115: 433-437.</ref><br />
**Diagnostic and therapeutic<ref>Chen SC, Lin FY, Lee PH, et al. Water-soluble contrast study predicts the need for early surgery in adhesive small bowel obstruction. Br J Surg 1998; 85: 1692-1694.</ref><br />
**100 cc of gastrografin through NG tube<br />
**Transit may be observed through serial radiographs<br />
***Contrast within the large bowel within 24 hrs suggest partial [[Special:MyLanguage/small bowel obstruction|small bowel obstruction]]<br />
***Contrast failing to reach large bowel within 24-48 hrs suggests complete obstruction, requiring laparotomy<br />
**Therapeutic, may reduce necessary operative rate by ~75%<ref>Choi HK et al. Therapeutic Value of Gastrografin in Adhesive Small Bowel Obstruction After Unsuccessful Conservative Treatment: A Prospective Randomized Trial. Annals of Surgery. 2002;236(1).</ref><br />
*Avoid barium as it becomes inspissated in bowel, causing complete obstruction<ref>Choi HK et al. Therapeutic Value of Gastrografin in Adhesive Small Bowel Obstruction After Unsuccessful Conservative Treatment: A Prospective Randomized Trial. Annals of Surgery. 2002;236(1).</ref><br />
**If perforation occurs with barium, leakage can be lethal<br />
**Gastrografin is water-soluble and relatively safer if perforation occurs<br />
**Be aware that anaphylactoid reactions and serious aspirations have occurred rarely with Gastrografin, however<ref>Skucas J. Anaphylactoid reactions with gastrointestinal contrast media. AJR Am J Roentgenol 1997; 168: 962-964.</ref><br />
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==Disposition==<br />
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*Normally outpatient<br />
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==See Also==<br />
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*[[Special:MyLanguage/Constipation (peds)|Constipation (peds)]]<br />
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==References==<br />
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<references/><br />
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[[Category:GI]]<br />
[[Category:Symptoms]]</div>FuzzyBot