Constipation
Basics
Description
Rome Criteria for the diagnosis of constipation requires 2 or more of the following for at least 3 mo:Description
- 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)
- Functional 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
Etiology
- Metabolic and endocrine:
- Diabetes
- Uremia
- Porphyria
- Hypothyroidism
- Hypokalemia (severe)
- Hypomagnesium (severe)
- 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
- Antiemetics (ondansetron)
- Antihistamines
- 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 of colon, rectum, or anus
- Hernia
- Volvulus
- Intestinal pseudo-obstruction
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Citation
Schaider, Jeffrey J., et al., editors. "Constipation." 5-Minute Emergency Consult, 6th ed., Lippincott Williams & Wilkins, 2020. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307013/all/Constipation.
Constipation. In: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307013/all/Constipation. Accessed November 14, 2024.
Constipation. (2020). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (6th ed.). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307013/all/Constipation
Constipation [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, Wolfe RER, Barkin AZA, Shayne PP, Rosen PP, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. [cited 2024 November 14]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307013/all/Constipation.
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