Constipation means stools that are infrequent, hard or difficult to pass. Most cases come from low fiber, low fluid, inactivity or medicines, but new constipation in an older adult can be a sign of a more serious problem.
Key symptoms
- Fewer than three bowel movements a week
- Hard, lumpy stools and straining
- Feeling of incomplete emptying
- Bloating and mild abdominal discomfort
What you find on exam
- Abdominal exam for distension, tenderness or a mass
- Inspection of the anus for fissures or hemorrhoids
- Rectal exam for hard stool, mass and sphincter tone
- Review medicines such as opioids, iron and anticholinergics
Tests
- Usually no tests needed for typical cases
- Blood count, calcium, glucose and thyroid tests if suspected
- Colonoscopy for alarm signs or if screening is due
- Abdominal X-ray if obstruction is suspected
Treatment basics
- More fiber, fluids and physical activity
- Bulk laxative such as psyllium
- Osmotic laxative such as polyethylene glycol
- Stimulant laxative such as senna or bisacodyl as needed; bowel regimen with opioids
Red flags
- Blood in the stool, weight loss or anemia
- New constipation after age 45
- Vomiting, severe pain and no passing of gas, suggesting obstruction
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.