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Constipation

S. Mimi Mukherjee, PharmD, BCPS, CDE and Sandra Marwill, MD, MPH Reviewed 06/2019
 


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

1
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

  • Ford AC, Moayyedi P, Lacy BE, et al. American College of Gastroenterology monograph on the management of irritable bowel syndrome and chronic idiopathic constipation. Am J Gastroent...

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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