Constipation

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Contents

More Specific Terms

Introduction

  • Fewer than 3 stools/week, passage of hard small stools, straining & the sense of incomplete evacuation.

Etiology

  • low fiber intake
  • inactivity

Epidemiology

  • the most common digestive complaint in the USA
  • affects over 2% of the population
  • 2-3 times more common in women than men
  • marked increase after age 65

Laboratory

Diagnostic-procedures

Radiology

Complications

  • Alarm features

Differential-diagnosis

Management

  • general considerations
  • stepwise management of chronic constipation [11]
  • stop all medications that may contipate, if possible
  • increase dietary fiber intake to 6-25 grams/day; increase fluid intake to >= 1.5 L/day; increase physical activity; bulk laxitive may be used provides fluid intake is >= 1.5 L/day
  • if step 2 fails, add sorbitol 70% 15-30 mL every 12-24 hours; max 150 mL/day
  • add stimulant laxative ( senna or bisocodyl) 2-3 times per week
  • use tap water enema or saline enema twice a week
  • oil retention enema for refractory constipation
  • comment: recommend step 4 prior to step 3
  • pharmaceutical agnets

More General Terms

Additional Terms

References

  1. Harrison's Principles of Internal Medicine, 13th ed. Companion Handbook, Isselbacher et al (eds), McGraw-Hill Inc. NY, 1995, pg 829-39
  2. Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 297-300
  3. Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998
  4. Harrison's Principles of Internal Medicine, 14th ed. Fauci et al (eds), McGraw-Hill Inc. NY, 1998, pg 242-43
  5. Prescriber's Letter 12(3): 2005 Constipation Myths Detail-Document#: [1] (subscription needed) [2]
  6. Journal Watch 25(10):82, 2005 Borowitz SM, Cox DJ, Kovatchev B, Ritterband LM, Sheen J, Sutphen J. Treatment of childhood constipation by primary care physicians: efficacy and predictors of outcome. Pediatrics. 2005 Apr;115(4):873-7. PMID: [3]
  7. Prescriber's Letter 14(5): 2007 Medications for constipation Detail-Document#: [4] (subscription needed) [5]
  8. Coccorullo P et al. Lactobacillus reuteri (DSM 17938) in infants with functional chronic constipation: A double-blind, randomized, placebo- controlled study. J Pediatr 2010 Oct; 157:598. PMID: [6]
  9. Kamm MA et al. Oral bisacodyl is effective and well-tolerated in patients with chronic constipation. Clin Gastroenterol Hepatol 2011 Jul; 9:577. PMID: [7]
  10. Prescriber's Letter 19(2): 2012 CHART: Treatment of Constipation in Children GUIDELINES: Managing functional constipation in children (2011) GUIDELINES: Evaluation and Treatment of Constipation in Infants and Children: Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (2006) Detail-Document#: [8] (subscription needed) [9]
  11. Geriatric Review Syllabus, 7th edition Parada JT et al (eds) American Geriatrics Society, 2010
  12. Geriatrics at your Fingertips, 13th edition, 2011 Reuben DB et al (eds) American Geriatric Society
  13. NIH Institute and Center Resources [10]
  14. National Guideline Clearinghouse
    - Prevention of constipation in the older adult population. (Registered Nurses Association of Ontario) ngc-guideline: [11]
    - Functional constipation and soiling in children University of Michigan Health System ngc-guideline: [12]
    - Evaluation and treatment of constipation in infants and children: recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. ngc-guideline: [13]
    - Constipation in children and young people. Diagnosis and management of idiopathic childhood constipation in primary and secondary care. National Collaborating Centre for Women's and Children's Health. ngc-guideline: [14]

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