Algorithmic Approach to the Diagnosis of Constipation - Flowchart
Algorithmic Approach to the Diagnosis of Constipation - Flowchart Constipation Constipation
«Flowchart»

Constipation

Constipation

Constipation

Abdominal pain workup to include anoscopy

Abdominal pain workup to include anoscopy

Abdominal pain workup to include anoscopy

Associated with significant pain

Associated with significant pain

Associated with significant pain

Yes

Yes

Yes

No

No

No

Hydrocortisone I&D, as appropriate

Hydrocortisone I&D, as appropriate

Hydrocortisone I&D, as appropriate

Hemorrhoids

Hemorrhoids

Hemorrhoids

Yes

Yes

Yes

No

No

No

End

End

End

Fissure

Fissure

Fissure

Yes

Yes

Yes

No

No

No

Stool softener

Stool softener

Stool softener

Refer

Refer

Refer

Consider IBD?

Consider IBD?

Consider IBD?

Yes

Yes

Yes

No

No

No

Refer to GI

Refer to GI

Refer to GI

Refer

Refer

Refer

Mass lesion

Mass lesion

Mass lesion

Yes

Yes

Yes

No

No

No

Urge to defecate

Urge to defecate

Urge to defecate

Yes

Yes

Yes

No

No

No

Dementia
Mental retardation
Diabetes mellitus
Myopathy
Symptoms of obstruction

Dementia
Mental retardation
Diabetes mellitus
Myopathy
Symptoms of obstruction

Dementia
Mental retardation
Diabetes mellitus
Myopathy
Symptoms of obstruction





Mild degree

Mild degree

Mild degree

Severe degree

Severe degree

Severe degree

↑ Activity
Assurance
Metamucil

↑ Activity
Assurance
Metamucil

↑ Activity
Assurance
Metamucil

↑

Functional; arrange follow-up evaluation

Functional; arrange follow-up evaluation

Functional; arrange follow-up evaluation

Inactivity older age

Inactivity older age

Inactivity older age

Yes

Yes

Yes

No

No

No

Flat plate abdominal

Flat plate abdominal

Flat plate abdominal

Refer surgical

Refer surgical

Refer surgical

Obstruction

Obstruction

Obstruction

Yes

Yes

Yes

No

No

No

↑ Fiber

↑ Fiber

↑ Fiber

↑

Rule out medications, depression

Rule out medications, depression

Rule out medications, depression

Rule out low-fiber diet

Rule out low-fiber diet

Rule out low-fiber diet

Yes

Yes

Yes

No

No

No

No

No

No

Functional; arrange follow-up evaluation

Functional; arrange follow-up evaluation

Functional; arrange follow-up evaluation

Stool in vault

Stool in vault

Stool in vault

Yes

Yes

Yes

No

No

No

Bowel program (enemas, MOM, lactulose)

Bowel program (enemas, MOM, lactulose)

Bowel program (enemas, MOM, lactulose)

Neurologic disorders


CVA
Cord lesion
Multiple sclerosis, ALS

Neurologic disorders


CVA
Cord lesion
Multiple sclerosis, ALS

Neurologic disorders


CVA
Cord lesion
Multiple sclerosis, ALS


CVA
Cord lesion
Multiple sclerosis, ALS

Yes

Yes

Yes

No

No

No

Pain relief

Pain relief

Pain relief

Recent abdominal surgery/pain?

Recent abdominal surgery/pain?

Recent abdominal surgery/pain?

Yes

Yes

Yes

No

No

No

Stool softeners, cathartics

Stool softeners, cathartics

Stool softeners, cathartics

Chronic debilitating disease (COPD, CHF, CRF)

Chronic debilitating disease (COPD, CHF, CRF)

Chronic debilitating disease (COPD, CHF, CRF)

Yes

Yes

Yes

No

No

No

Modify medications

Modify medications

Modify medications

Rule out constipating medications

Rule out constipating medications

Rule out constipating medications

Present

Present

Present

Not present

Not present

Not present

Treat appropriately

Treat appropriately

Treat appropriately

Rule out metabolic causes:


Hypocalcemia
Hypokalemia
Hypomagnesemia

Rule out endocrine causes:


Diabetes mellitus
Hypothyroidism

Rule out metabolic causes:


Hypocalcemia
Hypokalemia
Hypomagnesemia

Rule out endocrine causes:


Diabetes mellitus
Hypothyroidism

Rule out metabolic causes:


Hypocalcemia
Hypokalemia
Hypomagnesemia


Hypocalcemia
Hypokalemia
Hypomagnesemia

Rule out endocrine causes:


Diabetes mellitus
Hypothyroidism


Diabetes mellitus
Hypothyroidism

Present

Present

Present

Not present

Not present

Not present

Assurance, metamucil, linaclotide, lubiprostone

Assurance, metamucil, linaclotide, lubiprostone

Assurance, metamucil, linaclotide, lubiprostone

Functional; arrange follow-up evaluation

Functional; arrange follow-up evaluation

Functional; arrange follow-up evaluation

Symptom consistent with irritable bowel syndrome?

Symptom consistent with irritable bowel syndrome?

Symptom consistent with irritable bowel syndrome?

Yes

Yes

Yes

No

No

No