What are signs of bowel obstruction requiring referral?
No bowel movement, no gas, pain, distension, N/V
intestines have stopped working
What does inability to pass gas + vomiting suggest?
Possible bowel obstruction
not simple constipation.
What does rectal bleeding or dark/bloody stool indicate?
Alarm symptom requiring provider referral.
What does a sudden change in bowel habits >14 days suggest?
Possible cancer—requires medical evaluation.
What is a concerning amount of unintentional weight loss?
More than 10% of body weight.
Which systemic symptoms are alarm signs in constipation?
Anorexia and anemia.
What are examples of worsening constipation symptoms?
Failure to produce a bowel movement after treatment.
What does needing a laxative for >7 consecutive days indicate?
Worsening symptoms—requires referral.
What is severe, persistent constipation refractory to treatment?
An alarm symptom requiring medical evaluation.
What is the recommended daily fiber intake for constipation non-pharm treatment?
20–25 grams/day through dietary changes.
What is the recommendation regarding fluid intake for constipation?
Increase or maintain adequate fluid intake.
Why is responding to the urge to defecate important?
Ignoring the urge can worsen constipation.
What should be identified and treated when managing constipation?
Underlying causes contributing to constipation.
What are some constipation non-pharm treatments
↑ daily fiber intake
↑ exercise
↑ fluid intake OR maintain adequate fluid intake
Respond to the urge to defecate
Identify & treat underlying causes
What are bulk-forming agents for constipation?
Psyllium.
What is an example of an osmotic laxative?
Polyethylene glycol (PEG 3350).
What is an example of a stimulant laxative?
Senna.
What is the preferred non-pharm treatment for constipation in pediatrics?
Gradually increasing dietary fiber and physical activity.
Adequate hydration
What is the first line non-pharm treatment for constipation in pediatrics?
Increase physical activity
Are stimulant laxatives recommended for routine use in children?
No, avoid stimulant laxatives for routine use in pediatrics.
Why is constipation common during pregnancy?
Due to hormonal changes and iron supplementation.
What are preferred pharmacologic treatments for constipation in pregnancy? Why?
Bulk-forming agents or PEG, because they are not absorbed systemically.
When are bulk-forming or PEG laxatives recommended during pregnancy?
After non-pharmacologic measures such as increased fiber and exercise.
What non-pharmacologic measures should be tried first for constipation in pregnancy?
Increasing dietary fiber and exercise.
