Clinical Management of Patients Presenting with Constipation Urgent message: Constipation can be a sign of serious—even life- threatening—etiologies. Once non-benign causes have been ruled out, emphasis should be on evacuation and dietary and lifestyle changes to prevent recurrence. Claire West, MD, Samuel M. Keim, MD, MS, and Peter Rosen, MD INTRODUCTION onstipation is a common complaint, accounting for approximately 2.5 million doctor visits annu- ally. With increasing diffi- culty in obtaining a quick appointment with a pri- mary care physician, more and more of these patients are utilizing urgent care facilities. Although it is most of- ten seen in children, women, and patients over age 70, it is a reality that most people have experi- enced constipation at some time. It is a common © Scott Camazine/Phototake.com and often benign com- plaint that is easy to disregard as a minor nuisance. Nevertheless, it is associated with a wide range of eti- ologies, including some serious problems; initiation of effective therapy must begin with their elimination as possible factors. Constipation is defined as infrequent, firm, diffi- cult-to-pass stools. Obstipation is the inability to pass either stool or flatus. C w w w. j u c m . c o m Since constipation is of- ten a symptom of a more important underlying dis- ease, it is necessary to clar- ify with the patient the ac- tual characteristics, such as frequency, stool consis- tency, how these vary from normal for the patient, and other associated symptoms such as pain, bleeding, straining, nausea, vomit- ing, and weight loss. As a sudden new symp- tom in a patient, consti- pation should raise the level of concern for non- benign etiologies and not be presumed to be an au- tonomous entity. Ruling out serious and possibly life-threatening etiolo- gies is imperative. However, without other concerning associated symptoms, empiric treatment and outpa- tient evaluation of constipation is generally appropriate. Goals for treatment of functional constipation in urgent care focus on initial evacuation and prevention of recurrence. Education regarding dietary and lifestyle changes is often warranted. JUCM T h e J o u r n a l o f U r g e n t C a r e M e d i c i n e | Fe b r u a r y 2 0 0 9 9