Tag: constipation

Person holding abdomen, appearing in pain, wearing grey sweatshirt

What’s Causing My Abdominal Pain? Common Causes Explained

On By Dr. Scott RennieIn GastrointestinalLeave a comment
shutterstock_152569646Patients who present to the clinic or urgent care with abdominal pain can be some of the most challenging, because of the many different causes.  The job of your primary care or urgent care provider is to determine whether the pain is requiring immediate surgical evaluation. Medical providers must try to determine which patients can safely be observed and their symptoms treated and which patients require further investigation by a specialist such as a surgeon.  This is difficult because abdominal pain is often non-specific and presents with other symptoms very commonly. Triage:  We must urgently investigate abdominal pain in many patients.  Some patients require assessment of their airway, breathing and circulation followed by appropriate resuscitation.   Patients who may need surgery must be transferred to a facility where they can receive that care where appropriate nursing care, laboratory, surgical consultation, and radiology facilities are available. Patients who are having less severe pain or signs on exam may require consultation or referral for further management. Helpful information from patients: 1)   Time course of pain 2)   Location of pain 3)   Radiation of pain 4)   Factors that make the pain worse or better (such as foods or antacids) 5)   Associated symptoms including fever, chills, weight loss, nausea, vomiting, diarrhea, constipation, blood in the stools, jaundice, change in stool or urine color or diameter of the stools. 6)   Past medical history, including history of abdominal surgeries 7)   Family history of bowl disorders 8)   Alcohol intake 9)   Medications – including Tylenol, aspirin, and ibuprofen/aleve 10)  Menstral and contraceptive history in women Surgical abdomen:  Usually defined as a condition with rapidly worsening course without surgical intervention.  Obstructions of the intestines and peritonitis (inflammation/irritation of the inner wall of the abdomen that covers most abdominal organs) are reasons for referral to a surgeon. Sometimes tests will be ordered such as an abdominal radiograph,  CBC, comprehensive metabolic panel with liver enzymes, lipase, a urine analysis and pregnancy test (in women of childbearing potential). Other things we consider in determining the cause of the abdominal pain are the location of the pain and changes in where the pain radiates as well as how rapidly the pain gets worse. Some possible causes of abdominal pain are many – gallstones or gallbladder dysfunction, peptic ulcer, hiatal hernia, pneumonia, heart attack,  pancreatitis, heartburn, lactose intolerance, celiac sprue, pregnancy (including ectopic), endometriosis, sickle cell disease,  appendicitis, ovarian cyst or torsion, UTI, kidney stones, constipation, colitis, diverticulitis, pelvic inflammatory disease, gastroenteritis, intestinal ischemia (decreased blood flow to the intestines), diabetic ketoacidosis, kidney infection, abdominal aortic aneurism, or even trauma. Treatment:  Is tailored to address the cause of the pain.  If no cause can be found at your doctor’s office, the goal is to determine whether it is safe for you to go home with medications to help with the pain, and testing done as an outpatient or whether you need to be transferred to the hospital where further workup can be done immediately.   I hope that you have found this information useful.  Wishing you the best of health,

Scott Rennie, D.O.
Board Certified in Obesity Medicine and Family Medicine

This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.

Breakfast table with quinoa bowl, porridge with berries, sliced avocado, whole grain toast, and fresh fruits

I think I may be constipated – How do I know?

On By Dr. Scott RennieIn GastrointestinalLeave a comment
shutterstock_136335587Constipation is a common condition that I see in the clinic.  It’s a topic that few people enjoy talking about but is very common.  In fact, almost everyone gets constipated at some time during his or her life.  Women and the elderly are more commonly affected.  Though not usually serious, constipation can be a concern. Constipation:  A bowl motility disorder that occurs when bowl movements become less frequent.  The normal time between bowl movements varies widely from person to person – some people having a bowl movement 3 times a day, and others only 1 to 2 times per week.  In general, going more than 3 days without a bowl movement can cause pain.  After 3 days, the stool becomes harder and more difficult to pass. Some signs that you may be constipated (2 or more during 3 months at least):  Straining during bowl movement more than 25% of the time, lumpy or hard stools more than 25% of the time, sensation of anorectal obstruction, sensation of incomplete evacuation more than 25% of the time, manual maneuvering required to defecate, three or fewer bowl movements in a week. Symptoms of constipation:  Infrequent bowel movements and/or difficulty passing stool, swollen abdomen or abdominal pain, vomiting. Some causes of constipation:  Medications (especially strong pain medications such as narcotics, antidepressants or iron pills), low fiber diet, dehydration, disruption of regular diet or routine (traveling), inadequate activity or exercise, eating large amounts of dairy products, stress, resisting the urge to have a bowl movement (sometimes the result of painful hemorrhoids), overuse of laxatives, hypothyroidisms, Parkinson’s disease or Multiple Sclerosis, antacid medications containing calcium or aluminum, depression, eating disorders, irritable bowl syndrome, pregnancy and colon cancer. Treatment options: Increase hydration – drink 1.5 – 2 quarts of water each day Add fruits and vegetables to your diet Eat prunes and/or bran cereal A mild stool softener or laxative may be used Medication choices: 1)   Bulk forming laxative:  Metamucil, Citrucel, Fibercon or Benefiber 2)   Surfactants – Lower the surface tension of stool, thereby allowing water to more easily enter the stool.  Docusate/Colace is an example 3)   Osmotic agents: Cause intestinal water secretion and thereby increase stool frequency.  Examples are Polyethylene glycol (PEG) which is also known as Miralax.  Excessive use of these agents may result in electrolyte and volume overload in patients with renal or cardiac dysfunction.  Lactulose is a synthetic disaccharide that is not metabolized in the intestine, thus water and electrolytes remain in the lumen of the intestine. Sorbitol is a less expensive alternative.   Saline laxatives such as milk of magnesia and magnesium citrate are poorly absorbed and act as hyperosmolar solutions. 4)   Stimulant laxatives:  Dulcolax, senna and sodium picosulfate primarily exert their effects via alteration of electrolyte transport by the intestinal mucosa. 5)   Suppositories:  For treatment of functional defecation disorder – glycerin or bisacodyl suppositories may help liquefy stool and thereby overcome the obstruction. Other treatments for Constipation:  Behavioral approaches (habit training has been especially successful for children), biofeedback – a behavioral approach that can be used to correct inappropriate contraction of the pelvic floor muscles and external anal sphincter during defecation in patients with functional defecation disorder. Warning about constipation:  Since constipation can be a sign of possible bowl obstruction or even cancer – I recommend calling your doctor if this is a new problem for you, if you have blood in your stool, you are losing weight even if you’re not dieting, you have severely painful bowl movements, your constipation has lasted more than two weeks.   I hope that you have found this information useful.  Wishing you the best of health,

Scott Rennie, D.O.
Board Certified in Obesity Medicine and Family Medicine

This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.