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FOCUSED SHIFT VIEW

Constipation

Rarely the disease — often the mask.

Open full pathway
Educational first-pass aid. Reassess the patient, confirm doses and use local protocols.

1 · First minutes

  1. Constipation is a symptom — look for obstruction, ischemia, cord, calcium, thyroid, opioids.
  2. DRE in the frail and in “diarrhea” that may be overflow.
  3. New constipation + retention or saddle numbness = MRI for cauda, not lactulose.

2 · Escalate now if

  • Vomiting, distension, or an irreducible hernia
  • Pain out of proportion or bloody stool
  • New constipation with back pain, saddle numbness, or retention
  • Fever or peritonitis (stercoral perforation, megacolon)
  • Weight loss or iron-deficiency anemia in the older adult
  • Opioid ileus with a rock-hard abdomen

3 · Immediate workup

  • DRE; bladder scan if retention is possible
  • Glucose; POCUS for free fluid/AAA if surgical features

4 · Don’t miss

  • Bowel obstruction / volvulus
    Vomiting, distension, prior surgery, hernia, tympany — CT. Sigmoid/cecal volvulus is time-critical.
  • Mesenteric ischemia
    Pain out of proportion, AF, bloody stool — CTA, not a discharge laxative.
  • Cauda equina / cord compression
    New constipation plus back pain, saddle anesthesia, or urinary retention — emergency MRI.
  • Fecal impaction with overflow / stercoral colitis
    The frail elderly “diarrhea” that is overflow; DRE. Stercoral ulceration can perforate.

5 · Disposition lane

Admit

Fecal impaction needing serial enemas in a frail host, Ogilvie under monitoring, electrolyte or thyroid replacement, obstructing cancer staging.

Theatre / MRI / ICU

Obstruction with ischemia or perforation, volvulus, stercoral perforation, cauda equina.