Most cases donโ€™t require exam or clear diagnosis unless basic treatment unsuccessful [see below]

1.  Rare Possible Emergencies — New Constipation:

2.  Identify Red Flags Requiring Exam and Tests โ€“ New Constipation:

3.ย  If Anal Pain (especially if with Bowel Movements)

Examine / Treat for Anal Fissure or Thrombosed External Hemorrhoid

  • Sitz Baths: Sit in warm water 5-10 minutes (just immerse anus, not entire body
    • 2-4 times a day; can do it every 1-2 hours if patient feels motivated
  • Begin stool softeners, 2-4 times a day
  • If no better in a week, needs rectal exam.

4.  Stop (if possible) medications that may cause constipation.

  • Narcotic pain meds (opioids), Iron. Review side effects of all patient’s medications
  • Laxative Abuse. Need to discontinue laxatives very gradually

5.  Tentatively diagnose Irritable Bowel Syndrome (IBS)

Try Basic Treatment. If successful, no further work-up indicated

  • Very Basic (and Essential) Lifestyle Interventions:
    • Increase fiber in diet
    • Increase fluid intake
    • Increase exercise (cardio)
  • Medications (see Treatment for Constipation)

6.  Basic Treatment Unsuccessful

  • Rectal exam
  • Gynecological exam in older women for possible Rectocele (see Full Text)

7.  Laboratory Tests to Consider  (rarely helpful):

8.  Who Needs a Gastroenterology referral (& likely colonoscopy) ?

  • Persons >45-50 y.o. with new constipation who donโ€™t get better with Basic Treatment
  • Persons in #2 above

See Constipation โ€” Full Text for more in-depth explanations and discussions.

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