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Constipation

  • Common ddx

    • poor diet/bowel habit, narcotics, IBS, laxative overdose, hypothyroidism, anal fissure
  • Serious ddx

    • bowel obstruction, ileus, volvulus, IBD flare up, cancer
  • Labs

    • rectal exam, FOBT
    • CBC, Chem
    • TSH if suspect thyroid
    • lead level if suspect exposure
    • KUB
    • CT if suspect malignancy or diverticulitis
    • endoscopy
  • Symptomatic Tx

    • diet (fluid, fiber or psyllium 1 tsp tid), exercise
    • med choices
      • Peri-Colace 1-2 tabs PO 1-2 times daily
      • Dulcolax 10 mg PR tid
      • milk of magnesia 15-30 mL PO 1-2 times daily
      • magnesium citrate 240 mL PO once
      • lactulose or sorbitol 15-30 mL PO 1-2 times daily
      • MiraLAX 17 g PO
      • For kids: Mineral oil 5-15 mL (age 5-11) or 15-45 mL (age > 12) PO qday
    • If severe: Soap enema 1500 mL PR
    • disimpaction if fecal impaction
  • Obstructive ddx

    • bowel obstruction, IBD, Crohns, volvulus, stricture, neoplasm, colon cancer, fecal impaction
  • Decreased motility ddx

    • ileus, narcotics, hypothyroidism, Hirschprung's
  • Holding it in due to pain ddx

    • external hemorrhoids, anal fissure, abscess
  • Holding it in for other reasons ddx

    • poor bowel habit, sexual abuse
  • Dehydration ddx

    • diuretic abuse, poor fluid intake
  • Drugs side effects ddx

    • iron, narcotics, anticholinergics, Ca and Al antacids, barium swallow, lead poisoning, diuretic abuse, laxative abuse [melanosis coli]
  • Other ddx

    • poor diet, pregnancy, IBS, diverticulitis, megacolon, Chagas, hypercalcemia, hyperparathyroidism, hypokalemia
  • HPI

    • onset
    • quality
    • quantity, frequency, last bowel movement
    • alleviation, aggravation
  • ROS

    • fever, nightsweats, wt loss
    • cardio, pulm
    • GI: abdominal pain, nausea, vomiting, diarrhea, blood in stool, anal pain
    • cold intolerance
  • PMH

    • IBD
    • IBS
    • past abdominal surgery
    • cancer
    • thyroid disease
  • FH

    • colorectal cancer
    • thyroid disease
  • SH

    • diet
    • bowel habit: are you able to go whenever you want to
    • hx of sexual abuse
  • Meds

    • narcotic meds
    • new meds, laxatives, diuretics
  • Px

    • vitals
    • gen impression
    • ENT: goiter
    • cardio, pulm
    • abd: bowel sound, mass, pain, rebound tenderness
    • rectal exam: fissure, abscess, hemorrhoids, FOBT

  • Print | Citations

    Disclaimer: MDHero Workups is for educational use only, and is not meant to replace the clinical judgement of a professional. We do not guarantee the accuracy of any information on this website.