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Constipation

Daniel R. Matta, MD and Alexandra Wright, MBBS, Hons Reviewed 06/2022
 


BASICS

  • Unsatisfactory defecation characterized by infrequent stools, difficult stool passage, or both.

  • Characteristics include <3 bowel movements a week, hard stools, excessive straining, prolonged ...

DIAGNOSIS

ALERT

Red flags:

  • New onset after age of 50 years

  • Hematochezia/melena

  • Unintentional weight loss

  • Family history of colon cancer

  • Anemia

  • Neurologic defects

 

HISTORY

  • Assess onset of symptoms, number of bo...

TREATMENT

Address immediate concerns: 
  • Bloating/discomfort/straining: osmotic agents

  • Postoperative, after childbirth, hemorrhoids, fissures: stool softener to aid defecation

  • If impacted: manual disimpact...

ONGOING CARE

DIET

Increase soluble fiber (bloating and gas can be problematic with insoluble fiber): 
  • Gradually increase intake to 25 g/day over a 6-week period.

  • Oat bran (hard outer layer of cereal grai...

REFERENCES

1
Lewis SJ, Heaton KW. Stool form scale as a useful guide to intestinal transit time. Scand J Gastroenterol. 1997;32(9):920–924. [View Abstract on OvidMedline]
2
Lee-Robichaud H, Thomas K, Mor...

ADDITIONAL READING

  • Bharucha AE, Lacy BE. Mechanisms, evaluation and management of chronic constipation. Gastroenterology. 2020; 158:1232-1249.

  • Bharucha AE, Dorn SD, Lembo A, ...

CODES

ICD10

  • K59.00 Constipation, unspecified

  • K59.01 Slow transit constipation

  • K59.09 Other constipation

  • K59.02 Outlet dysfunction constipation

SNOMED

  • 14760008 Constipation (disorder)

  • 35298007 Slow transit co...

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