Constipation - Revision history

Ostermayer: Marked this version for translation

2026-01-14T12:54:27Z

Marked this version for translation

← Older revision		Revision as of 12:54, 14 January 2026
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	<languages/>		<languages/>
	<translate>		<translate>
			<!--T:1-->
	''This page is for '''adult''' patients; for pediatric patients see [[Special:MyLanguage/constipation (peds)\|constipation (peds)]].''		''This page is for '''adult''' patients; for pediatric patients see [[Special:MyLanguage/constipation (peds)\|constipation (peds)]].''

	==Background==		==Background== <!--T:2-->

			<!--T:3-->
	[[File:Diameters of the large intestine.png\|thumb\|Normal inner diameters of colon sections.]]		[[File:Diameters of the large intestine.png\|thumb\|Normal inner diameters of colon sections.]]
	[[File:Rectum anatomy en.png\|thumb\|Anatomy of the anus and rectum.]]		[[File:Rectum anatomy en.png\|thumb\|Anatomy of the anus and rectum.]]
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	===Red flags===		===Red flags=== <!--T:4-->

			<!--T:5-->
	*Weight loss		*Weight loss
	*[[Special:MyLanguage/Rectal bleeding\|Rectal bleeding]]/melena		*[[Special:MyLanguage/Rectal bleeding\|Rectal bleeding]]/melena
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	==Clinical Features==		==Clinical Features== <!--T:6-->

			<!--T:7-->
	[[File:BristolStoolChart.png\|thumb\|Bristol Stool Chart.]]		[[File:BristolStoolChart.png\|thumb\|Bristol Stool Chart.]]
	*Decreased frequency of bowel movements		*Decreased frequency of bowel movements
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	==Differential Diagnosis==		==Differential Diagnosis== <!--T:8-->

	</translate>		</translate>
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	==Evaluation==		==Evaluation== <!--T:9-->


	===Work up===		===Work up=== <!--T:10-->

			<!--T:11-->
	*Digital rectal exam		*Digital rectal exam
	*Abdominal panel		*Abdominal panel
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	===Diagnosis===		===Diagnosis=== <!--T:12-->

			<!--T:13-->
	*Diagnosis is frequently clinical		*Diagnosis is frequently clinical
	*In patients with concerning symptoms/risk factors, CT can confirm diagnosis and rule out more emergent conditions		*In patients with concerning symptoms/risk factors, CT can confirm diagnosis and rule out more emergent conditions


	==Management==		==Management== <!--T:14-->

			<!--T:15-->
	*Adequate fluid (1.5L per day)		*Adequate fluid (1.5L per day)
	*Fiber (10gm per day)		*Fiber (10gm per day)
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	===Medication options===		===Medication options=== <!--T:16-->

			<!--T:17-->
	*Emollient		*Emollient
	**[[Special:MyLanguage/Docusate\|Docusate]] (Colace): 100mg QD-BID (facilitates mixture of stool fat and water)		**[[Special:MyLanguage/Docusate\|Docusate]] (Colace): 100mg QD-BID (facilitates mixture of stool fat and water)
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	***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>		***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>

	====Gastrografin PO====		====Gastrografin PO==== <!--T:18-->

			<!--T:19-->
	*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>		*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>
	**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>		**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>
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	==Disposition==		==Disposition== <!--T:20-->

			<!--T:21-->
	*Normally outpatient		*Normally outpatient


	==See Also==		==See Also== <!--T:22-->

			<!--T:23-->
	*[[Special:MyLanguage/Constipation (peds)\|Constipation (peds)]]		*[[Special:MyLanguage/Constipation (peds)\|Constipation (peds)]]


	==References==		==References== <!--T:24-->

			<!--T:25-->
	<references/>		<references/>

			<!--T:26-->
	[[Category:GI]]		[[Category:GI]]
	[[Category:Symptoms]]		[[Category:Symptoms]]
	</translate>		</translate>

Ostermayer: Prepared the page for translation

2026-01-04T21:57:34Z

Prepared the page for translation

Show changes

Rossdonaldson1: /* Background */

2025-04-23T15:50:26Z

Background

← Older revision		Revision as of 15:50, 23 April 2025
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	==Background==		==Background==
	[[File:Diameters of the large intestine.png\|thumb\|Normal inner diameters of colon sections.]]		[[File:Diameters of the large intestine.png\|thumb\|Normal inner diameters of colon sections.]]
			[[File:Rectum anatomy en.png\|thumb\|Anatomy of the anus and rectum.]]
	*Acute constipation is intestinal obstruction until proven otherwise		*Acute constipation is intestinal obstruction until proven otherwise

Rossdonaldson1: /* Background */

2024-02-14T18:38:07Z

Background

← Older revision		Revision as of 18:38, 14 February 2024
Line 1:		Line 1:
	''This page is for '''adult''' patients; for pediatric patients see [[constipation (peds)]].''		''This page is for '''adult''' patients; for pediatric patients see [[constipation (peds)]].''
	==Background==		==Background==
			[[File:Diameters of the large intestine.png\|thumb\|Normal inner diameters of colon sections.]]
	*Acute constipation is intestinal obstruction until proven otherwise		*Acute constipation is intestinal obstruction until proven otherwise

Rossdonaldson1: /* Work up */

2024-02-14T18:14:39Z

Work up

← Older revision		Revision as of 18:14, 14 February 2024
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	**Chemistry ([[hypokalemia]] or [[hypercalcemia]])		**Chemistry ([[hypokalemia]] or [[hypercalcemia]])
	**LFTs + lipase		**LFTs + lipase
			**Consider coagulation studies (PT, PTT, INR), as a marker of liver function
	*Consider [[TSH]] if concern for [[hypothyroid]] related [[constipation]]		*Consider [[TSH]] if concern for [[hypothyroid]] related [[constipation]]
	*Consider [[lactate]] if concern for [[stercoral colitis]]		*Consider [[lactate]] if concern for [[stercoral colitis]]

Rossdonaldson1: /* Evaluation */

2024-02-14T18:06:07Z

Evaluation

← Older revision		Revision as of 18:06, 14 February 2024
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	==Evaluation==		==Evaluation==
	===Work up===		===Work up===
	*~~Rectal~~ exam		*Digital rectal exam
	*Abdominal panel		*Abdominal panel
	**CBC		**CBC
	**Chemistry ([[hypokalemia]] or [[hypercalcemia]])		**Chemistry ([[hypokalemia]] or [[hypercalcemia]])
	**LFTs + lipase		**LFTs + lipase
	*Consider [[TSH]] if concern for [[~~hypothyroidism~~]]		*Consider [[TSH]] if concern for [[hypothyroid]] related [[constipation]]
	*Consider [[lactate]] if concern for [[stercoral colitis]]		*Consider [[lactate]] if concern for [[stercoral colitis]]
	*CT if abdominal tenderness, elderly, or severe presentation		*CT if abdominal tenderness, elderly, or severe presentation
	**'''Constipation should not cause abdominal tenderness on exam'''		**'''Constipation should not cause abdominal tenderness on exam'''
			**CT may show stool burden in colon/rectum

	===Diagnosis===		===Diagnosis===

Rossdonaldson1: /* Evaluation */

2024-02-14T18:02:25Z

Evaluation

← Older revision		Revision as of 18:02, 14 February 2024
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	==Evaluation==		==Evaluation==
			===Work up===
	*Rectal exam		*Rectal exam
	*~~Guaiac~~		*Abdominal panel
	*Chemistry ([[hypokalemia]] or [[hypercalcemia]])		**CBC
	*CT ~~abdomen/pelvis (~~if ~~suspect obstruction)~~		**Chemistry ([[hypokalemia]] or [[hypercalcemia]])
	*~~TSH~~		**LFTs + lipase
			*Consider [[TSH]] if concern for [[hypothyroidism]]
			*Consider [[lactate]] if concern for [[stercoral colitis]]
			*CT if abdominal tenderness, elderly, or severe presentation
			**'''Constipation should not cause abdominal tenderness on exam'''

			===Diagnosis===
			*Diagnosis is frequently clinical
			*In patients with concerning symptoms/risk factors, CT can confirm diagnosis and rule out more emergent conditions

	==Management==		==Management==

Rossdonaldson1: /* Clinical Features */

2024-02-07T23:14:35Z

Clinical Features

← Older revision		Revision as of 23:14, 7 February 2024
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	==Clinical Features==		==Clinical Features==
			[[File:BristolStoolChart.png\|thumb\|Bristol Stool Chart.]]
			*Decreased frequency of bowel movements
			*Hard, dry, and/or difficult to pass stool

	==Differential Diagnosis==		==Differential Diagnosis==

Rossdonaldson1: /* Differential Diagnosis */

2020-06-04T17:19:31Z

Differential Diagnosis

← Older revision		Revision as of 17:19, 4 June 2020
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	{{Constipation DDX}}		{{Constipation DDX}}
	{{Anorectal DDX}}		{{Anorectal DDX}}
			{{DDX abdominal distention}}

	==Evaluation==		==Evaluation==

Rossdonaldson1 at 21:45, 24 June 2019

2019-06-24T21:45:37Z

← Older revision		Revision as of 21:45, 24 June 2019
Line 1:		Line 1:
			''This page is for '''adult''' patients; for pediatric patients see [[constipation (peds)]].''
	==Background==		==Background==
	*Acute constipation is intestinal obstruction until proven otherwise		*Acute constipation is intestinal obstruction until proven otherwise