Constipation is defined as either stool frequency of < 3 times per week or difficulty in passing stools. It is a quite frequent presenting complaint in the ED and many of us treat it like a trivial issue. However, there are a few life-threatening conditions which might present with the chief complaint of constipation. Often it is seen in the elderly and those with multiple medical problems, complicating both their assessment and treatment.
- What do you exactly mean when you say "I am constipated?" (Dig into the frequency, amount, caliber of stools)
- Associated Symptoms (Tenesmus, Blood in stools, pain while defecating, Weight or Appetite changes, Pain Abdomen, Nausea/Vomiting, Alternating Diarrhea)
- Duration of constipation (Acute v/s Chronic)
- Ask for any neurological disease, thyroid disease, diabetes, spinal cord pathology?
- Medications? (Opioids, Anticholinergics,CCBs, Diuretics, Iron, Aluminium Antacids, NSAIDs)
- Lifestyle (Bed Ridden, Dietary intake of Water and fibre, Sedentary)
Causes of Constipation (Life Threats)
- Bowel Obstruction
- Perforated Viscus
- Bowel Ischemia
- HypoK, HyperCa
- Inflammatory Bowel Disease
- Diet and Lifestyle
- Renal Failure, Hypothyroidism
- Painful lesions (haemorrhoids, fissures)
- Irritable Bowel Syndrome
- Laxative Abuse
- Neuro Disorders (Spinal Cord Disease, Multiple Sclerosis, Parkinson's, Diabetes)
What labs do need to order?
- Renal Function
- AXR (suspected bowel obstruction) - Read more on this at LIFTL
Those who look stable, normal vital signs and a BENIGN abdominal exam can be worked up as an out-patient. Treat with laxatives once bowel obstruction had been ruled out.
Have a "discharge conversation", discuss your concerns and advise on dietary and lifestyle habits and appropriate follow up.
- Start asking the question - What is causing CONSTIPATION?
- Common cause include lifestyle habits, dietary factors and medications
- Faces seen on plain radiographs is normal. Imaging should be used to exclude other pathologies.