Constipation
Revision as of 11:08, 15 July 2016 by Neil.m.young (talk | contribs) (Text replacement - " abd " to " abdominal ")
Background
- Acute constipation is intestinal obstruction until proven otherwise
- Red flags:
- Weight loss
- Rectal bleeding/melena
- Nausea/vomiting
- Fever
- Rectal pain
- Change in stool caliber
Differential Diagnosis
Acute
- Bowel obstruction
- Tumor, stricture, hernia, adhesion, volvulus, fecal impaction
- New medicine
- Opiods, antipsychotic, anticholinergics, antacid, antihistamines
- Change in exercise
- Change in diet
- Pain rectal conditions (e.g. anal fissure, hemorrhoids)
Chronic
- Acute causes
- Hypothyroidism
- Electrolytes
- Hypokalemia
Work-Up
- Rectal exam
- Guaiac
- Chemistry (hypoK or hyperCa)
- Acute abdominal series (if suspect obstruction)
- TSH
Treatment
- Stress adequate fluid (1.5L per day), fiber (10gm per day), and exercise
- Meds
- Fiber
- Bran: 1 cup daily
- Psyllium (Metamucil): 1 teaspoon TID
- Emollient
- Docusate (Colace): 100mg QD-BID (facilitates mixture of stool fat and water)
- Stimulants
- Saline laxative
- Milk of mangesia: 15-30 mL QD-BID
- Magnesium citrate: 100-240 mL QD-BID
- Hyperosmolar agents
- Lactulose 15-30 mL QD-BID
- Polyethylene glycol: 1 gallon/4h
- Miralax: 17gm
- Fiber