What is the workup plan and differential diagnosis for a 2-year-9-month-old patient presenting to the Emergency Department (ED) with constipation?

From the Guidelines

Constipation in a 2-year-9-month-old patient requires a thorough workup plan and differential diagnosis. The initial step involves taking a careful history to evaluate defecation patterns, dietary habits, and stool consistency, as well as assessing for symptoms of dyssynergic defecation or alarm symptoms such as blood in stool or accompanying weight loss 1.

Key Components of the Workup Plan

• A thorough medical history to identify potential causes of constipation, including medication use, eating and drinking habits, level of physical activity, and pre-existing conditions such as irritable bowel syndrome or diverticular disease 1
• Physical examination, including abdominal examination, perineal inspection, and digital rectal examination (DRE) to assess for signs of constipation, such as fecal impaction or rectal prolapse 1
• Screening tests to rule out underlying diseases that may be contributing to constipation, such as hypothyroidism or spinal cord compression syndrome 1

Differential Diagnosis

• Functional constipation: characterized by infrequent bowel movements, hard stools, and straining during defecation, with no underlying medical condition causing the symptoms 1
• Opioid-induced constipation (OIC): constipation triggered or worsened by opioid analgesics, which requires a different management approach 1
• Defecatory disorders: characterized by difficulty with evacuation, such as pelvic floor dysfunction or anorectal obstruction, which may require specialized management 1
• Other medical conditions: such as hypothyroidism, diabetes, or spinal cord injuries, which can cause constipation as a symptom 1 By following this workup plan and considering the differential diagnosis, healthcare providers can develop an effective management plan for constipation in a 2-year-9-month-old patient.

From the Research

Workup Plan for Constipation

The workup plan for a 2-year-9-month-old patient presenting to the Emergency Department (ED) with constipation involves:

• Focused lab tests and structural evaluation 2
• A therapeutic trial of fiber and laxatives 2
• Specialized tests if necessary 2
• A detailed medical history and a focused anorectal examination 3, 4, 5

Differential Diagnosis

The differential diagnosis for constipation includes:

• Primary constipation:
  • Slow transit constipation 2, 6, 5
  • Outlet obstruction 2
  • Defecatory disorders 6, 5
• Secondary constipation:
  • Medication-induced constipation 6, 4, 5
  • Anatomic alterations 6
  • Chronic diseases 5

Evaluation and Management

Evaluation of constipation begins with:

• A detailed medical history 3, 4, 5
• A focused anorectal examination 3, 4
• Medication reconciliation 5 Management of constipation includes:
• Dietary changes:
  • Increased fiber intake 2, 3, 6, 4, 5
  • Adequate fluid intake 4, 5
• Medications:
  • Laxatives (osmotic, stimulant, and intestinal secretagogues) 2, 6, 4, 5
  • Biofeedback therapy for defecatory disorders 3, 6, 4, 5
• Physical therapy:
  • Pelvic floor therapy with biofeedback 5
• Surgery:
  • Colectomy for slow-transit constipation 6
  • Other surgical options for refractory constipation 5