Constipation in Emergency Medicine Workup

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

Laboratory Studies

  • Serum chemistry may exclude any metabolic causes of constipation, such as hypokalemia and hypercalcemia.
  • Complete blood count (CBC) may reveal any anemia that might be associated with rectal bleeding (gross or occult).
  • Thyroid function tests may be helpful with patients suspected of having hypothyroidism.
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Imaging Studies

  • Plain film of the abdomen (upright and flat) and an upright chest film
    • These studies underscore the amount of stool present in a patient's colon. Differentiation of fecal impaction, bowel obstruction, and fecalith is possible. Large amount of stool throughout the colon. Large amount of stool throughout the colon. Large stool mass in hepatic flexure of the colon. Large stool mass in hepatic flexure of the colon. Colon distension secondary to fecal impaction. Colon distension secondary to fecal impaction.
    • Diagnosis of fecaliths is important because of the dreaded complication of stercoral ulcers, which can lead to colonic perforation. Stercoral perforation is a rare but life-threatening surgical emergency of perforation due to pressure necrosis that can lead to peritonitis.
    • Diabetic gastropathy, as well as fecal impaction, may be seen in patients with diabetic neuropathy.
    • Residual barium (from barium enemas) can be visualized.
    • Scleroderma and other connective-tissue diseases may be complicated by motor disturbances that mimic colonic obstruction on plain film.
    • Myxedema ileus is a consequence of hypothyroidism.
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Other Tests

  • An extensive workup of the constipated patient is performed on an outpatient basis and usually occurs after approximately 3-6 months of failed medical management.
  • Anatomic tests include Gastrografin enema, proctosigmoidoscopy, and colonoscopy.
  • Physiologic tests include the following: colonic transit study (which uses radio-opaque markers in patients with suspected slow-transit constipation), defecography (which identifies internal rectal intussusception), and anorectal manometry and surface anal electromyography (which help to confirm pelvic floor dyssynergia or anismus).
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Procedures

  • Anoscopy: Routinely perform anoscopy on all constipated patients to visualize anal fissures, ulcers, hemorrhoids, and local anorectal malignancy.
  • Digital disimpaction: A well-lubricated gloved finger might be required in patients with lower anorectal impactions.
  • Warm water enemas: These usually are unpopular among the nursing staff and probably are not necessary within the ED.
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Proceed to Treatment & Management
 
 
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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