CHAPTER 32 Constipation Jan

The term constipation refers to a symptom or complex of symptoms and not a specific diagnosis. Patients and health care providers often define constipation differently. Most health care providers define constipation based on stool frequency. Patients often use the term constipation to describe a broad set of complaints, including straining, hard or infrequent stools, pain during a bowel movement, a feeling of incomplete evacuation, or abdominal bloating. Constipation may be acute (new for the patient) or chronic. Chronic constipation is defined as the presence of symptoms for at least 3 months. In clinical practice, attempting to identify the cause of the symptoms will often result in the best chance of effective treatment and will help determine disposition. A definitive diagnosis often is not possible in the emergency department (ED), and appropriate follow-up evaluation should be arranged in those cases. When constipation becomes severe with constant pain, some clinicians use the term obstipation. Obstipation represents the progression of the symptom of constipation toward bowel obstruction. In the ED, the complaint of constipation should be of concern when it represents a significant change from a patient’s own normal pattern that is creating discomfort for the patient. This change may manifest as a decrease in frequency of defecation, sudden and persistent change in the character or amount of stools (especially decrease in stool caliber), blood in the stool, or problems expelling the stool.