Constipation in Emergency Medicine Follow-up

  • Author: Dave A Holson, MD, MBBS, MPH; Chief Editor: Barry E Brenner, MD, PhD, FACEP   more...
 
Updated: Jun 14, 2010
 

Further Inpatient Care

  • Patients with the following warrant admission and surgical evaluation:
    • Obstructive symptoms
    • Nonrectal impactions
    • Fever and dehydration
  • Diabetes mellitus is an immunosuppressive illness and judicious evaluation of this patient population is warranted.
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Further Outpatient Care

  • Further outpatient care should include contact with the primary care provider to ensure follow-up.
  • Referral to a gastroenterologist is warranted for patients with the following:
    • Constipation of recent onset
    • Rectal bleeding or heme-positive stool
    • Chronic constipation associated with weight loss, anemia, or change in stool consistency
    • Refractory constipation
    • Rectal prolapse
    • Constipation requiring chronic laxative use
  • Future directions
    • Prokinetic agents that stimulate serotonergic enteric nervous system receptors
      • Although significant promise had been shown with this new class of drugs, 2 agents, cisapride and tegaserod have been withdrawn from the US market in 2000 and 2008, respectively.
      • The mixed 5-HT4 receptor agonist/5-HT3 receptor antagonist renzapride has been tested to assess its efficacy and safety in the treatment of chronic constipation.[15]
    • Linaclotide, an agonist of guanylate cyclase type-c, has just completed phase 3 clinical trials and has been shown to increase SBMs and CSBMs.[13]
    • Enteric nervous system neurotrophin - Neurotrophin-3 stimulates the development, growth, and function of the nervous system.
    • Electrical stimulation of the colon
    • Stem cells to repopulate dysfunctional neurons
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Inpatient & Outpatient Medications

  • Bulk-forming agent: Psyllium (eg, Metamucil) increases frequency and softens stool consistency.
  • Emollient: Docusate sodium (eg, Colace) improves hard bowel movements.
  • Lukewarm tap water enema: This treatment facilitates rapid relief of symptoms and may help regulate further bowel movements.
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Deterrence/Prevention

Deterrence and prevention of constipation may include the following:

  • Adequate fluid intake (ie, eight 8-oz glasses of water per day)
  • Regular exercise
  • High-fiber diet
  • Avoidance or decreased use of constipating medications
  • Regular bowel habits with attempted bowel movements at the same time daily may help symptoms, especially after meals when the gastrocolic reflex is strongest.
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Complications

Complications of constipation may include the following:

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Prognosis

  • Most active patients do well with medical management.
  • Constipation is an ongoing problem for patients who are bedridden or otherwise debilitated.
  • Colectomy usually is reserved for patients with slow transit constipation who fail to respond to 6 months of medical management with good patient compliance.
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Patient Education

  • Listening to patients' concepts of normal bowel activity is important.
  • Instituting a behavior modification program allows patients to become more aware of and responsive to normal urges to defecate.
  • Emphasize the importance of a high-fiber diet.
  • Emphasize adequate fluid intake.
  • Emphasize regular exercise.
  • For excellent patient education resources, visit eMedicine's Esophagus, Stomach, and Intestine Center. Also, see eMedicine's patient education articles Constipation in Adults and Constipation in Children.
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Contributor Information and Disclosures
Author

Dave A Holson, MD, MBBS, MPH  Assistant Professor of Emergency Medicine, Mount Sinai School of Medicine; Director, Department of Emergency Medicine, Queens Hospital Center

Dave A Holson, MD, MBBS, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, National Medical Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

William K Chiang, MD  Associate Professor, Department of Emergency Medicine, New York University School of Medicine; Chief of Service, Department of Emergency Medicine, Bellevue Hospital Center

William K Chiang, MD is a member of the following medical societies: American Academy of Clinical Toxicology, American College of Medical Toxicology, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Eugene Hardin, MD, FAAEM, FACEP  Former Chair and Associate Professor, Department of Emergency Medicine, Charles Drew University of Medicine and Science; Former Chair, Department of Emergency Medicine, Martin Luther King Jr/Drew Medical Center

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Barry E Brenner, MD, PhD, FACEP  Professor of Emergency Medicine, Professor of Internal Medicine, Program Director, Emergency Medicine, University Hospitals, Case Medical Center

Barry E Brenner, MD, PhD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Chest Physicians, American College of Emergency Physicians, American College of Physicians, American Heart Association, American Thoracic Society, Arkansas Medical Society, New York Academy of Medicine, New York Academy of Sciences, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

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Large amount of stool throughout the colon.
Large stool mass in hepatic flexure of the colon.
Colon distension secondary to fecal impaction.
Pseudo-obstruction secondary to fecal impaction.
Distended transverse colon.
Distended rectum.
 
 
 
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