Constipation

S. Mimi Mukherjee, PharmD, BCPS, CDE and Sandra Marwill, MD, MPH Reviewed 06/2018

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

FOLLOW UP RECOMMENDATIONS

Encourage exercise and physical activity.

Patient Monitoring

If functional constipation persists, revisit secondary causes.

DIET

Increase soluble fiber (bloating an...

REFERENCES

Ori Y, Rozen-Zvi B, Chagnac A, et al. Fatalities and severe metabolic disorders associated with the use of sodium phosphate enemas: a single center’s experience. Arch Intern Med. 201...

ADDITIONAL READING

Basilisco G, Coletta M. Chronic constipation: a critical review. Dig Liver Dis. 2013;45(11):886–893. [View Abstract on OvidMedline]
Bove A, Pucciani F, Bellini M, et al. Conse...

CODES

ICD10

K59.00 Constipation, unspecified
K59.01 Slow transit constipation
K59.09 Other constipation
K59.02 Outlet dysfunction constipation

ICD9

564.00 Constipation, unspecified
564.01 Slow transit consti...

CLINICAL PEARLS

Constipation (especially with normal transit time) is common. Reversible risk factors include inadequate hydration, sedentary lifestyle, poor dietary habits, and medication side effect...

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