Test Your Knowledge: Constipation in the Emergency Department

Each year, over 1.3 million patients visit the emergency department for constipation. Most cases are benign, but serious complications, such as fecal impaction and stercoral colitis, must be ruled out. Evidence to guide the evaluation and treatment of constipation in the emergency department is limited, and many of the decades-old treatments have not been studied in modern, rigorous, controlled trials.

In the emergency department, constipation is a clinical diagnosis, and ideal management includes excluding dangerous mimics or complications and, for most patients, discharging the patient with a bowel regimen tailored to the likely cause of their constipation, with appropriate referral to primary or specialty care.  

Our recent issue Emergency Department Evaluation and Management of Constipation evaluates consensus guidelines on management of constipation as well as the early data on the newer prescription medications for chronic and opioid-induced constipation. 

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Here are a few key points:

• Guidelines define constipation as reduced bowel movement frequency and/or abnormally firm stool consistency. 
• ED visits for constipation in the U.S. have increased dramatically in recent years, from an estimated 500,000 visits per year in 2006 to 1,300,000 in 2017.
• The Bristol Stool Form Scale scoring system for stool appearance is commonly used in clinical practice and research. See Figure 1 in the issue.
• Consistency of stool is a better marker for speed of colonic transit than frequency of movements.
• Constipation can be caused by some medical conditions (see Table 2) and by medications (see Table 3). 

Read the full issue and earn 4 AMA PRA Category 1 Credits™.