Acute Constipation

Aka: Acute Constipation, Organic Constipation, Constipation due to Organic Causes, Secondary Constipation

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II. Signs and Symptoms suggestive of organic cause

  1. See Constipation for red flag symptoms

III. Causes

  1. See Constipation Causes
  2. See Functional Constipation (Chronic Constipation)
  3. Common
    1. Colorectal Carcinoma
    2. Diverticulitis
    3. Sigmoid or cecal Volvulus
    4. Fecal Impaction
  4. Uncommon
    1. Adhesions
    2. Hernia
    3. Pelvic abscess
    4. Intestinal foreign body

IV. Evaluation

  1. See Constipation for history and examination
  2. Examination should include Fecal Occult Blood Test

V. Labs

  1. Complete Blood Count
  2. Serum Electrolytes (esp. Potassium)
  3. Blood Glucose
  4. Serum Creatinine
  5. Serum Calcium
  6. Thyroid Stimulating Hormone (TSH)

VI. Diagnostics: Initial

  1. XRay: Flat and Upright Abdomen
    1. Shows level of fecal obstruction
  2. Colonoscopy (preferred)
  3. Flexible Sigmoidoscopy (if Colonoscopy not available)
  4. Barium Enema (performed with Flexible Sigmoidoscopy)
    1. Abrupt termination of barium suggests Colon Cancer
    2. Smooth tapering of barium: sigmoid or cecal Volvulus
    3. Colonic narrowing with "saw-tooth": Diverticulitis
  5. CT Abdomen

VII. Diagnostics: Other Testing

  1. Anal Manometry
    1. Detects Hirschsprung's Disease
    2. Also detects Pelvic Floor Dysfunction (high pressure)
  2. Balloon insertion
    1. Evaluates rectal emptying
    2. Abnormal in Pelvic Floor Dysfunction
  3. Defecography (fluoroscopy)
    1. Detects Pelvic Floor Dysfunction
  4. Colonic transit study (XRay with radiopaque Sitzmark markers)
    1. Markers should pass by Day 5 in normal patients
    2. Detects slow colonic transit
    3. Detects pelvic outlet obstruction

VIII. Management

  1. Evaluate and treat underlying cause
  2. If no cause identified, then consider empiric therapy
    1. See Functional Constipation

IX. References

  1. Cheskin (1995) in Ambulatory Medicine, p. 476-81
  2. Friedman (1991) Problem Oriented Diagnosis, p. 192-4
  3. Sartor in Dornbrand (1992) Ambulatory Care, p. 221-5
  4. Arce (2002) Am Fam Physician 65(11):2283-90 [PubMed]
  5. Borum (2001) Prim Care 28(3):577-90 [PubMed]
  6. Wald (2000) Med Clin North Am 84(5):1231-46 [PubMed]

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