Constipation

Constipation accounts for 1.3 million emergency department visits annually, necessitating a rigorous approach to distinguish benign cases from life-threatening conditions like bowel obstruction, malignancy, or stercoral colitis. While physical examinations, including digital rectal exams, remain critical for identifying fecal impaction, abdominal radiographs often provide little diagnostic value compared to the targeted use of CT imaging for severe pathology. Treatment protocols emphasize disimpaction and the use of evidence-based osmotic laxatives like polyethylene glycol, as docusate lacks proven efficacy. For patients with refractory opioid-induced constipation, peripheral mu-opioid receptor antagonists offer a high-cost but effective intervention. Clinicians must also remain vigilant regarding medication-induced constipation, as common agents like NSAIDs, anticholinergics, and even oral contraceptives can contribute to the condition, requiring a comprehensive review of patient history and current pharmacological regimens to ensure effective management.