Definition
• Reduced frequency of stool (<3/wk), &/or difficult passage of hard stool
Approach
• Nature: Duration, severity, character of stool, pain, fever, medication use, prior episodes
Simple Constipation (Including Stool Impaction)
History
• Poor diet, decreased fluid/fiber intake, decreased mobility, constipating medications
Physical Findings
• Firm stool in the rectal vault, palpable stool on abd exam, minimal abd ttp
Evaluation
• Abdominal x-ray or CT if need to r/o obstruction, or to confirm Dx in high-risk pt
Treatment
• Manual disimpaction if needed
• Colace, mineral oil, magnesium citrate, enema (esp in elderly)
• Natural bulking agents (Metamucil) when constipation resolves
Disposition
• Home
Rectal Foreign Body
History
• FB insertion usually during sex play or iatrogenic
Physical Findings
• FB in rectum on exam or anoscopy
Evaluation
• Abdominal x-ray to eval location/shape
Treatment
• Removal w/ forceps traction while the patient bears down. Impacted object may cause proximal vacuum suction; can pass foley around object to break vacuum seal & use balloon to pull back on object.
• Removal in OR if unsuccessful or if sharp object w/ risk of perforation
Disposition
• Home if removed
Pearl
• Procedural sedation may be needed to sufficiently dilate anus to remove FB in ED