Constipation is a topic covered in the 5-Minute Emergency Consult.

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Basics

Description

Rome Criteria for the diagnosis of constipation requires 2 or more of the following for at least 3 mo:
  • Straining >25% of the time
  • Hard stools >25% of the time
  • Incomplete evacuation >25% of the time
  • 2 or fewer bowel movements per wk

Pediatric Considerations
  • 3% of pediatric outpatient visits are because of defecation disorders.
  • Children with cerebral palsy often develop functional constipation.
  • Can be classified into subgroups:
    • Constipation with anatomical origins (anal stenosis/strictures, ectopic anus, imperforate anus, sacrococcygeal teratomas)
    • Colonic neuromuscular disease (Hirschsprung disease)
    • Defecation disorders (functional constipation and nonretentive fecal soiling)
    • Function fecal retention
  • Most common cause of fecal retention and soiling in children is functional fecal retention:
    • Caused by fears associated with defecation
    • Associated with irritability, abdominal cramps, decreased appetite, early satiety

Etiology

  • Metabolic and endocrine:
    • Diabetes
    • Uremia
    • Porphyria
    • Hypothyroidism
    • Hypercalcemia
    • Pheochromocytoma
    • Panhypopituitarism
    • Pregnancy
  • Functional and idiopathic:
    • Colonic irritable bowel syndrome
    • Diverticular disease
    • Colonic inertia
    • Megacolon/megarectum
    • Pelvic intussusception
    • Nonrelaxing puborectalis
    • Rectocele/sigmoidocele
    • Posthysterectomy syndrome
    • Descending perineum
  • Pharmacologic:
    • Analgesics
    • Anesthetics
    • Antacids
    • Anticholinergics
    • Anticonvulsants
    • Antidepressants
    • Antihypertensives
    • Calcium channel blockers
    • Diuretics
    • Ferrous compounds
    • Laxative abuse
    • MAOIs
    • Opiates
    • Paralytic agents
    • Parasympatholytics
    • Phenothiazines
    • Psychotropics
  • Neurologic:
    • Central Parkinson disease
    • Multiple sclerosis
    • Cerebrovascular accidents
    • Spinal cord lesions/injury
    • Peripheral Hirschsprung disease
    • Chagas disease
    • Neurofibromatosis
    • Autonomic neuropathy
  • Mechanical obstruction:
    • Neoplasm
    • Stricture
    • Hernia
    • Volvulus

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Citation

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TY - ELEC T1 - Constipation ID - 307013 Y1 - 2016 PB - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307013/all/Constipation ER -