Constipation

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docB

docB

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I see more constipation in the ER than I can believe. Apparently, after you reach the age of 60, and particularly if you are male, you are required to devote several hours per day to pondering your bowels. At some point you also will suddenly decide it's perfectly reasonable to CALL 911 AND HAVE AN AMBULANCE COME CODE 3 TO YOUR DOOR because you are constipated. I frequently ask them "When the 911 operator answered and asked 'What's your EMERGENCY?' and you said 'I'm constipated.' didn't that seem at least a little odd?"
Anyway, aside from my rant, I want to bring up treatment of constipation in the ED. I generally do a rectal, heme test, manual disimpaction and 2 fleets up the kazoo on my first pass. If they're heme -, benign belly and poop after the enemas home they go. If that doesn't work a real enema with an enema bag and a special recipe will work but I usually can't find an enema bag or a nurse willing to do it. What do you guys do?
 
Somebody really should do a study, because I see next to no old people with constipation, but when i worked in the more arid desert I saw it all the time. I did a pediatric rotation in Phoenix and by god I swear all the kids in that city are constipated. Oddly, back in my home institution (also in the desert) it wasn't really that much of a problem.

Here in LA, I haven't seen much in the way of fecal impaction in either elderly or young. A few times in the almost a year since I've been here, and one of those was in a ******ed child with chronic bowel problems.
 
docB said:
It could be the desert or the vast quantity of elderly I have but everyone here is stopped up and they feel free to come to the ER for it.
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You don't happen to know how much medicare charges for a manual disimpaction, do you? 🙂
 
docB said:
It could be the desert or the vast quantity of elderly I have but everyone here is stopped up and they feel free to come to the ER for it.
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gambling increases the incidence of constipation
 
in regards to the above post, i was just fos
 
Sessamoid said:
Somebody really should do a study, because I see next to no old people with constipation
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You had to have seen old croner's laying bricks at your old digs down here in FL... there are nursing homes about as often as a dirty Circle K around here, and anytime one of them forgets to drink their prune juice its over to the TGH ER with the "sophisticated chest pain and stroke center" and apparently an "emergency clogged colon center."

Q
 
southerndoc said:
I wonder if we're supposed to log it as a procedure?
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Heheh, he said "log". The pun was unintentional, right?
 
20 yoear old male who refused to use the bathroom (defecate) for 2 MONTHS because the toilet in his house didnt work. result-2 trips to the OR for manual disimpaction, full work up, and possibly facing a colectomy. Most importantly-his hospital bill was over $20,000. Just discharged him yesterday. I will try to upload his abdominal film if someone could tell me how to do it.

I mean-what the hell are we teaching people in school. And I am sure more things like this will become evident to me as I train, but why in the hell don't we have classes in "common sense for your health" throughout gradeschool and high school. We can name the capitols of obscure European countries and what the ancient romans did, but have no idea that you have to take a dump at least 1-2 times a week. The absolute stupidity people have on simple health issues boggles my mind. We talk about the high cost of health care, well, from what I have experienced, if people had a freaking clue about their bodies besides the what the genitals did, our healthcare industry would be transformed.
 
Very hesitant do do a manual disimpaction in the elderly in part due to the possibility of a vagal episode occurring resulting in a code. Actually used this philosophy one day and gave the patient an enema.....however, he proceeded to scream in pain, carry on, and eventually had a syncopal episode anyway. Oh well...damned if you do, damned if you don't.

I have heard that a milk and mollasses enema works well. Also there is the standard Mag citrate. I have given lactulose for constipation and that works well also.

However, typically stay away from the manual disimpacations.
 
My anatomy cadaver was a small elderly woman, but her colon took up 9/10ths of her abdominal cavity. I don't think she pooed for over a month.

(no disrespect)
 
Ischial Tuberosity Spread??... can I hear a yeaaaaaah from all those DO's out there?? 😀
 
EMIMG said:
Very hesitant do do a manual disimpaction in the elderly in part due to the possibility of a vagal episode occurring resulting in a code. Actually used this philosophy one day and gave the patient an enema.....however, he proceeded to scream in pain, carry on, and eventually had a syncopal episode anyway. Oh well...damned if you do, damned if you don't.
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That's because if they are truly impacted as opposed to just constipated you can give all the enemas in the world and it won't work, fleets just leaks out and you can't pass a tube through all the rock hard poo to do a soapsuds(at least not without them screaming in pain as the tube tunnels through their rectal mucosa) You can also give lactulose until their colon explodes without getting that cannonball in their rectum to pass. Sometimes the only answer is to glove and gown up and go mining for turds. I sometime use conscious sedation for this. If you've ever seen how much better someone who has fecal impaction feels afterwards it makes it nearly worthwhile.
 
jonb12997 said:
Ischial Tuberosity Spread??... can I hear a yeaaaaaah from all those DO's out there?? 😀
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:laugh: Personally, I like doming the pelvic diaphragm.
 
ERMudPhud said:
That's because if they are truly impacted as opposed to just constipated you can give all the enemas in the world and it won't work, fleets just leaks out and you can't pass a tube through all the rock hard poo to do a soapsuds(at least not without them screaming in pain as the tube tunnels through their rectal mucosa) You can also give lactulose until their colon explodes without getting that cannonball in their rectum to pass. Sometimes the only answer is to glove and gown up and go mining for turds. I sometime use conscious sedation for this. If you've ever seen how much better someone who has fecal impaction feels afterwards it makes it nearly worthwhile.
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So look... I'm a premed... and I don't know a whole lot about medicine yet. I'm wondering, is the obstruction usually within reach of the fingers? And what happens when it's not?

Though I'm sure I'll be getting intimately aquainted with this procedure as a med student, I'd appriciate it if someone could help me out here...

Thanks
 
I have not yet performed a manual disimpaction. I am shooting for a lifetime free from poop mining.
 
stoic said:
So look... I'm a premed... and I don't know a whole lot about medicine yet...
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My advice, don't worry/think about it yet... sometimes it's better not to contemplate things too much... i'm already in school and I'm trying not to think about all those fun things 😱 that I'll eventually get to do
 
Seaglass said:
I have not yet performed a manual disimpaction. I am shooting for a lifetime free from poop mining.
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Same here - trying to avoid the razor's edge.

It was kind of funny, then, when the Chair of Surgery at Duke came down, stuck a finger in the colostomy he made, and mushed up the turd. Hey, there was NO WAY I was going to mess with someone else's procedure.
 
Apollyon said:
Hey, there was NO WAY I was going to mess with someone else's procedure.
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Wow, that was awfully sporting of you. What a great team player!

Take care,
Jeff
 
i would never have a med student do a procedure i have not yet done
 
Apollyon said:
You can stick your sarcasm in YOUR colostomy.

Maybe it's not like that at UTMB, but, if a Duke surgeon has done it, they don't want anyone else to touch it.
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Of course it's like that at UTMB. I wasn't trying to be mean about it and would have done the same thing. Yes, I was being sarcastic but not in the way you took it. Sorry about the miscommunication.

Take care,
Jeff
 
BTW, speaking of UTMB and colostomies and all....you probably know we have a prison hospital. Care to guess what the prisoners most popular thing to stick in their colostomies is? Apparently, they actually try to avoid the colostomy take down because it decreases their earning potential. 😱

Yet another reason I never want to go to jail.

Take care,
Jeff
 
Jeff698 said:
BTW, speaking of UTMB and colostomies and all....you probably know we have a prison hospital. Care to guess what the prisoners most popular thing to stick in their colostomies is? Apparently, they actually try to avoid the colostomy take down because it decreases their earning potential. 😱

Yet another reason I never want to go to jail.

Take care,
Jeff
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I gotcha. That's what happens when I post, post-call.

Somewhere in the EM forum archives, someone mentions syphilis in the colostomy. Ick!

Way back when, when I interviewed at NYMC (who also have a prison hospital), the director of admissions said, "We love our prisoners. We have to protect them from our students", when I enquired about safety. Now, I had to do an ethics module on research on prisoners earlier this week. How times change.
 
Jeff698 said:
BTW, speaking of UTMB and colostomies and all....you probably know we have a prison hospital. Care to guess what the prisoners most popular thing to stick in their colostomies is? Apparently, they actually try to avoid the colostomy take down because it decreases their earning potential. 😱

Yet another reason I never want to go to jail.

Take care,
Jeff
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:scared::scared::scared:
 
Jeff698 said:
BTW, speaking of UTMB and colostomies and all....you probably know we have a prison hospital. Care to guess what the prisoners most popular thing to stick in their colostomies is? Apparently, they actually try to avoid the colostomy take down because it decreases their earning potential. 😱

Yet another reason I never want to go to jail.

Take care,
Jeff
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😕


:idea:



:scared:


dear god


--your friendly neighborhood scarred for life caveman
 
The original citation of that practice can be found in the "what I learned from my patient's thread" Always a pleasure to read about it again 😱
 
beanbean said:
The original citation of that practice can be found in the "what I learned from my patient's thread" Always a pleasure to read about it again 😱
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I was just trying to remember if I'd posted that one or not. For some strange reason, that story just sticks, well, somewhere.

Take care,
Jeff
 
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