Constipation Flashcards
Definition of Constipation
Subjective complaints including straining, fullness, bloating, incomplete evacuation, hard stools
Objective signs include hard “rabbit pellet” stools, massive stool in the rectal vault, fullness on abdominal examination, x-ray findings
Frequency may also be relevant in context of pts normal habits
Rule of thumb for constipation
If defecations decrease sufficiently to cause discomfort than the pt has constipation
Causes
Functional
Intrinsic colon disease: stenosis, stricture, hernia, tumors, ischemic colitis, diverticulitis, endometriosis
Neuromuscular: scleroderma, amyloidosis, CVA, MS, diabetic autonomic neuropathy
In kids: excessive cows milk, transition from break milk to formula, transition to table food, lack of privacy, lack of solule fiber
Red Flag Symptoms
Weight loss
Rectal bleeding/melena
Nause and/or Vomiting
Rectal pain
Decrease in stool caliber
Paradoxical diarrhea
Acute onset
Note: acute suggests organic cause; chronic suggests functional cause
Evaluation
PE:
- signs of hypothyroidism;
- abdominal exam for masses, tenderness, absent or high pitched bowel sounds;
- perianal changes (fissures, hemorrhoids, stenosis);
- rectal exam (amt/consistency of stool in rectum, rectal mass, FOBT, anal sphincter tone
Lab:
- FOBT, BMP, TSH
- Plain abdominal films
- Maybe CT or Colonoscopy
Treatment
Fluids
Aggressive use of fiber
Osmotic laxatives (polyethylene glycol)
Stimulant and other laxatives
When very severe i.e. megacolon or megarectum, consider surgery–colectomy or ileorectostomy
