Constipation
Acute Constipation
search
Acute Constipation
, Organic Constipation, Constipation due to Organic Causes, Secondary Constipation
See also
Constipation
Constipation Causes
Pediatric Constipation
Functional Constipation
Signs and Symptoms suggestive of organic cause
See
Constipation
for red flag symptoms
Causes
See
Constipation Causes
Common
Colorectal Carcinoma
Diverticulitis
Sigmoid or cecal
Volvulus
Fecal Impaction
Uncommon
Adhesions
Hernia
Pelvic abscess
Intestinal foreign body
Types
Functional causes (not organic)
Normal Transit Constipation
Perception of
Constipation
despite normal stool transit
Associated with psychological stress
Responds to fiber supplementation with adequate hydration
Slow Transit
Constipation
Prolonged stool transit (more common in young women)
Diagnosed with 6 of 24 Sitzmark markers visible on XRay at 120 hours post ingestion
Related to decreased meal related peristalsis
Refractory to dulocolax,
Cholinergic
s, fiber
May respond to biofeedback
Outlet
Constipation
(pelvic floor dysfunction)
Stool
not expelled when reaches
Rectum
Symptoms include excessive straining at soft stool, sometimes requiring disimpaction
Responds to biofeedback and
Relaxation Technique
s
Evaluation
See
Constipation
for history and examination
Examination should include
Fecal Occult Blood Test
Labs
Complete Blood Count
Serum
Electrolyte
s (esp.
Potassium
)
Blood Glucose
Serum Creatinine
Serum Calcium
Thyroid Stimulating Hormone
(TSH)
Diagnostics
Initial
XRay: Flat and Upright
Abdomen
Shows level of fecal obstruction
Colonoscopy
(preferred)
Flexible Sigmoidoscopy
(if
Colonoscopy
not available)
Barium Enema
(performed with
Flexible Sigmoidoscopy
)
Abrupt termination of barium suggests
Colon Cancer
Smooth tapering of barium: sigmoid or cecal
Volvulus
Colonic narrowing with "saw-tooth":
Diverticulitis
CT Abdomen
Diagnostics
Other Testing
Anal Manometry
Detects
Hirschsprung's Disease
Also detects pelvic floor dysfunction (high pressure)
Balloon insertion
Evaluates rectal emptying
Abnormal in pelvic floor dysfunction
Defecography (fluoroscopy)
Detects pelvic floor dysfunction
Colonic transit study (XRay with radiopaque Sitzmark markers)
Markers should pass by Day 5 in normal patients
Detects slow colonic transit
Detects pelvic outlet obstruction
Management
Evaluate and treat underlying cause
If no cause identified, then consider empiric therapy
See
Functional Constipation
References
Cheskin (1995) in Ambulatory Medicine, p. 476-81
Friedman (1991) Problem Oriented Diagnosis, p. 192-4
Sartor in Dornbrand (1992) Ambulatory Care, p. 221-5
Arce (2002) Am Fam Physician 65(11):2283-90 [PubMed]
Borum (2001) Prim Care 28(3):577-90 [PubMed]
Wald (2000) Med Clin North Am 84(5):1231-46 [PubMed]
Type your search phrase here