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Constipation (DDx (Medication side-effect (Recent) (Antipsychotics,…

- - - - Fam His
    - - Recent
    - - Post op
  - - - Worse constipation with stress --> IBS (Abdo pain/Discomfort 3 or more days per month in the past 3 months that is improved with bowel movement. Discomfort associated with change in consistency of stools/Number of bowel movement? If 2 or more over 6 months --> IBS). Pass mucus. Long standing.
    - - Longstanding
- - - - Nausea/Vomiting?:Intestinal Obstruction
      - Fecal incontinence?: Fecal impaction
      - New medication: Medication side effect
      - Abdo pain/Cramps: Intestinal obstruction(eg cancer, diverticulitis, IBS,ileus)
      - Able to pass gas?: No suspect Complete intestinal obstruction
      - Tell me what you have eaten in the past 24 hr working backwards from when you first entered here?
        
        Decrease in fibre and liquid and lead to constipation
      - What were your bowel habits like prior to this episode?
        
        Bouts of constipation alternating with diarrhea: Colon cancer, IBS, diabetic neuropathy, fecal impaction
        
        If abnormal--> Chronic condition progressing to complete obstruction
      - Has your level of activity changed recently? Sedentary lifestyle or bed rest can lead to constipation
      - Have you had abdominal surgery or radiation? : Strictures, adhesions
      - Have you suffered a back injury?:Spinal cord trauma
      - Do you have new weakness in your legs?Saddle anesthesia? Difficulty passing urine?: Spinal cord damage from tumor or trauma
    - - How often bowel movement? What is normal?: Less than 2 per week --> Slow transit constipation
      - Increase urinary frequency/thirst: Diabetic autonomic neuropathy
      - Weight gain, decrease energy levels, swelling in legs: Hypothyroidism
      - How is your sleep? Appetite? Interest in things? Mood? Concentration?: Depression --> constipation
      - Level of activity: Decrease --> Constipation
      - Pregnancies? Multiparity is associated with defecatory disorder
      - Diet pass 24 hrs: Low fibre, low liquid
      - Increase fiber improve means normal transit constipation
      - If take laxative, have you had a bowel movement without laxative? If no suggest slow transit constipation. If use laxative abuse can lead to constipation. After purging with laxative, might need a few days to have normal bowel movement.
      - Medication side effect
      - When you feel like emptying your bowels? Do you heed it? Failure to heed it chronically may lead to chronic rectal distention, lax muscle tone, slow transit time, and chronic constipation
      - Do you have the feeling of incomplete evacuation: IBS
      - Abdo pain /bloating associated with bowel movement: IBS or intestinal obstruction
        
        If relieved by it : IBS
        
        If acute: Intestinal obstruction(Strictures, colon cancer, fecal impaction etc)
- - - - Yes: Consider constipation caused by associated condition
      - No
        
        New medications?
        
        Yes
        
        Medication induced constipation
        
        No
        
        Acute
        
        Consider recent bed rest, change in diet, psychosocial stressor as possible cause of constipation
        
        Chronic
        
        Difficulty passing even soft stools or enema fluid, need to press around pelvic floor to defecate, need to digitally evacuate, feeling of blockage, difficulty relaxing muscles to move bowels
        
        Defacatory disorder
        
        Pain relieved by bowel movement, passing mucus, sense of incomplete evacuation, symptoms increased by stress, bloating
        
        Normal transit constipation (IBS)
        
        Fewer than 2 bowel movements per week, laxative dependent, constipation since childhood
        
        Slow transit constipation