Constipation

Acute Constipation

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Acute Constipation, Organic Constipation, Constipation due to Organic Causes, Secondary Constipation

  • See also
  1. Constipation
  2. Constipation Causes
  3. Pediatric Constipation
  4. Functional Constipation
  • Findings
  • Signs and Symptoms suggestive of organic cause
  1. See Constipation for red flag symptoms
  • Causes
  1. See Constipation Causes
  2. See Medication Causes of Constipation
  3. See Functional Constipation (Chronic Constipation)
  4. Common
    1. Colorectal Carcinoma
    2. Diverticulitis
    3. Sigmoid or cecal Volvulus
    4. Fecal Impaction
  5. Uncommon
    1. Adhesions
    2. Hernia
    3. Pelvic abscess
    4. Intestinal foreign body
  • Evaluation
  1. See Constipation for history and examination
  2. See Abdominal Pain Evaluation
  3. Rectal Exam to exclude impaction, blood
  4. Precautions
    1. "Constipation" is a diagnosis of exclusion in higher risk groups (e.g. elderly)
  • Labs
  1. Complete Blood Count
  2. Serum Electrolytes (esp. Potassium)
  3. Blood Glucose
  4. Serum Creatinine
  5. Serum Calcium
  6. Thyroid Stimulating Hormone (TSH)
  • Diagnostics
  • Initial
  1. XRay: Flat and Upright Abdomen
    1. Shows level of fecal obstruction
  2. Colonoscopy (preferred)
  3. Flexible Sigmoidoscopy (if Colonoscopy not available)
  4. Barium Enema (performed with Flexible Sigmoidoscopy)
    1. Abrupt termination of barium suggests Colon Cancer
    2. Smooth tapering of barium: sigmoid or cecal Volvulus
    3. Colonic narrowing with "saw-tooth": Diverticulitis
  5. CT Abdomen
  • Diagnostics
  • Other Testing
  1. Anal Manometry
    1. Detects Hirschsprung's Disease
    2. Also detects Pelvic Floor Dysfunction (high pressure)
  2. Balloon insertion
    1. Evaluates rectal emptying
    2. Abnormal in Pelvic Floor Dysfunction
  3. Defecography (fluoroscopy)
    1. Detects Pelvic Floor Dysfunction
  4. Colonic transit study (XRay with radiopaque Sitzmark markers)
    1. Markers should pass by Day 5 in normal patients
    2. Detects slow colonic transit
    3. Detects pelvic outlet obstruction
  • Management
  1. Evaluate and treat underlying cause
  2. No red flag symptoms or signs
    1. See Functional Constipation (Chronic Constipation)
    2. Treat empirically
    3. If no improvement consider Organic Constipation
  3. Red Flag symptoms or signs above suggest organic cause
    1. See Organic Constipation (Acute Constipation)
  • References
  1. Cheskin (1995) in Ambulatory Medicine, p. 476-81
  2. Friedman (1991) Problem Oriented Diagnosis, p. 192-4
  3. Sartor in Dornbrand (1992) Ambulatory Care, p. 221-5
  4. Arce (2002) Am Fam Physician 65(11):2283-90 [PubMed]
  5. Borum (2001) Prim Care 28(3):577-90 [PubMed]
  6. Wald (2000) Med Clin North Am 84(5):1231-46 [PubMed]