Constipation
Adrien Selim, MD, and Vanessa Cardy, MD
Background
- No clearly accepted definition
- Hard stools, strain, less frequent, feeling of incomplete evacuation
- <3 bowel movements/wk
- Etiology
- Primary/Idiopathic
- Slow colonic transit
- Dyssynergic defecation
- Pelvic floor muscles are not coordinated during defecation
- Secondary causes:
- Gastrointestinal obstructions
- Neurological
- Endocrine/metabolic
- Medications
- Pregnancy
Clinical Findings
- Do history and physical
- Abdominal, rectal, neurological exam
- Labs
- Thyroid stimulating hormone
- Ca and K
- Complete blood count and iron
- Others to consider
- Fecal occult blood test
- Colonoscopy
Management
- Dietary counseling
- ↑ fluid and fiber intake
- ↑ exercise
- Bulk-forming laxatives
- Stimulants
- Osmotic laxatives
- Glycerin suppositories
- Enemas