By Susan S. Baker
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Additional resources for Algorithm for Evaluation and Treatment of Constipation
Yes Surgical management 33 32 No Consider time-limited Rx with : . Cisapride . Biofeedback . PEG solution . training . Stimulant laxatives . Bowel Intensive psych 34 No Yes Treatment effective? 35 . Maintain Rx . Wean Consider other tests : . MRI of spine . Barium emena . Anorectal . Full-thickness biopsy . manometry metabolic tests . Colonic manometry . Other Psych evaluation/Rx . Transit time . Inpatient observation 36 Yes Relapse? 37 38 No Yes Abnormal? No Observation 39 Treatment 40 Re-evaluate 41 42 .
Occult blood (if indicated) Constipation : Delayed or difficult defecation for > 2 weeks 1 2 Condition Delayed passage of meconium? Yes Rectal biopsy 3 Question 4 No No Action Yes Hirschsprung disease? 5 Sweat test Surgical management 6 7 Yes . Evaluate further . Specialty consultation Are there any red flags? , fever, vomiting, bloody diarrhea, failure to thrive, anal stenosis, tight empty rectum, impaction, 8 distension? No 9 No Functional constipation 11 Exclusively breast-fed > 2 wk old? 10 Yes Treatment : .
35 Treat accordingly Re-evaluate 36 28 27 25 Surgical management Treatment effective?