Most cases don’t require exam or clear diagnosis unless basic treatment unsuccessful [see below]
1. Rare Possible Emergencies — New Constipation:
- With new significant Abdominal Pain, could be Bowel Obstruction. See Abdominal Pain.
- With new Fever, could be the body’s reaction to an infection. See Fever.
2. Identify Red Flags Requiring Exam and Tests – New Constipation:
- With significant weight loss (possible Colon Cancer)
- In the very Elderly or Debilitated (possible Fecal Impaction)
- With unusual back pain (maybe Spinal Cord Disease)
- With large amount of Blood (possible Colon Cancer or Ulcerative Colitis)
- In persons having Anal Sex, esp. with many partners (possible rectal Gonorrhea / Chlamydia)
- Persons >50 with alternating constipation & diarrhea (possible Colon Cancer)
- Persons with a close family history of Colon Cancer
3. If Anal Pain (especially if with Bowel Movements)
- 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):
- Complete Blood Count (CBC) – for low hemoglobin (bleeding from a tumor)
- Comprehensive Metabolic Panel – for high calcium, low potassium, high glucose (Diabetes)
- TSH (thyroid test) – for Hypothyroidism
- ESR &/or CRP — if very high, might suggest the possibility of Colon Cancer or Ulcerative Colitis
- Rectal STD tests if unprotected rectal sex (for Gonorrhea & Chlamydia)
8. Who Needs a Gastroenterology referral (& likely colonoscopy) ?
- Persons >45-50 y.o. with new constipation who don’t get better with Basic Treatment
- Persons in #2 above
See Constipation — Full Text for more in-depth explanations and discussions.