I. Problem. A 4-year-old boy has infrequent and painful bowel movements.
II. Immediate Questions
A. What is patient's usual pattern of stooling? Normal frequency varies from 4 times daily in infants to once every 3 days in children.
B. Age at onset of symptoms? Consider congenital anomalies, obstruction, or chronic diseases if constipation has been present since infancy. Functional constipation starts in toddler or preschool years.
C. Consistency and size of stool? Hard, large stool that is painful to pass is consistent with the diagnosis of constipation regardless of stool frequency.
D. Symptoms when having a bowel movement? Pain may be due to large or hard stool, anal fissure, or, less commonly, perianal streptococcal infection. Functional constipation results in recurrent cycle: pain with passing stool ^ withhold stool ^ increased stool volume in rectum ^ dilated rectum, decreasing sensory function ^ increased stool volume ^ pain with passing stool, and so on.
E. Any associated symptoms (eg, abdominal pain, bloating, distention)? Patients with severe constipation have decreased appetite and weight loss. Approximately 30% of patients have day or night enuresis, or both, and ~60% have recurrent abdominal pain.
F. Difficulties with toilet training? Coercive training or resistance may lead toddlers to withhold stool, starting a recurrent cycle of functional constipation.
G. What is patient's usual diet? Diets low in fiber, high in complex carbohydrates, and high in dairy products contribute to slowed bowel elimination.
H. Any associated fecal soiling? Most encopresis occurs in association with chronic constipation (eg, retentive encopresis). The full, distended rectum loses the ability to signal the urge to pass stool, which, in turn, leads to stool leakage.
I. What medication(s) does patient take? Constipation is a common side effect of many prescribed, over-the-counter, and alternative remedies.
J. Pertinent past or present medical history? Acute injury, illness, or hospitalization is a common precipitator; reasons may include decreased activity, medications, or electrolyte disturbance. Underlying endocrine, neuromuscular, or chronic disease may alter bowel habits.
K. Any stressful events in home or school environment? Stress may affect diet, sleep, and activity level and thus produce changes in bowel habits.
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Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.