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Constipation (DDx (Drugs (Analgesics (narcotics, NSAIDs), Anticholinergics…
Constipation
DDx
E- abnormality (Hypokalemia, Hypercalcemia)
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Psychiatric (depression, dementia)
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Drugs
Analgesics (narcotics, NSAIDs)
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Endocrine (Hypothyroidism, DM)
Mx
Non-pharmacological
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Review Medication regime, reduce dosages or substitute
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If bowel regimen fails, start Polyethylene glycol (Peg3350 high dose; if fails again, consider Lubiprotone, Biofeedback therapy (dyssynergic defecation), Alvimopan, methylnaltrexone for opioid-induced constipation
Sx
Definition
< 3 bowel movements in one wk and/or hard stools, straining , sense of blockade, needing manual maneuvers or incomplete evacuation on more than 25% of occasions for at least 12 wks
In the elderly, chronic constipation may present as fecal impaction
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