›Avoid sodium phosphate enema in CKD or heart failure
›Fecal impaction pathway
›Manual disimpaction
›Topical lidocaine jelly
›Analgesia or procedural sedation if needed
›Post disimpaction regimen
›Polyethylene glycol daily
›Stimulant laxative short term
›Suspected bowel obstruction pathway
›Bowel rest
›NPO
›NG tube if persistent vomiting or significant distension
›Resuscitation
›Isotonic crystalloid
›Electrolyte correction
›Consultation
›General surgery early
›GI consultation for suspected malignancy obstruction when stable
›Antibiotics when complication concern
›If perforation concern, broad spectrum per local protocol
›If ischemia concern, broad spectrum per local protocol
Reassessment loop
›Interval reassessment
›After each intervention
›Pain trajectory
›Nausea and vomiting trajectory
›Objective outputs
›Passage of stool
›Passage of flatus
›Escalation triggers
›New peritoneal signs
›Rising lactate or worsening acidosis
17Disposition/dispo31
ICU criteria
›Critical care needs
›Septic shock pattern
›Hypotension after fluids
›Vasopressor requirement
›Suspected bowel ischemia with instability
›Rising lactate with hypotension
›Peritonitis
Inpatient admission criteria
›Admission indications
›Confirmed bowel obstruction
›CT obstruction findings
›Persistent vomiting
›Stercoral colitis
›CT colitis findings
›Systemic inflammatory response
›Failed ED disimpaction
›Persistent severe symptoms
›Inability to tolerate oral intake
Observation pathway criteria
›Short stay candidates
›Moderate dehydration responding to fluids
›Partial obstruction under protocol
›Need for repeated enemas with monitoring
Discharge criteria
›Safe discharge features
›No alarm features
›Benign abdominal exam
›Tolerating oral intake
›Stool passage or clear improvement
›Reliable follow up and return ability
Follow up timing
›Follow up plan
›Primary care within 3 to 7 days
›GI referral within weeks for chronic or recurrent
›Urgent referral for cancer concern features
18Discharge Instructions/di24
Copy discharge instructions
›Diagnosis summary
›Constipation
›No signs of bowel blockage found today
›Medications
›Polyethylene glycol 17 g in fluid daily
›Senna 2 tablets at bedtime as needed
›Avoid additional laxatives if vomiting or worsening abdominal pain
›Hydration and diet
›Increase fluids
›Increase fiber gradually
›Activity
›Walking daily if able
›Avoid straining
›Follow up
›Primary care within 3 to 7 days
›Earlier follow up if symptoms persist
›Return to emergency
›Severe or worsening abdominal pain
›Vomiting that does not stop
›Cannot pass gas
›Fever
›Blood in stool
›New weakness or numbness
›Trouble urinating
19References/r6
Guidelines and key sources
›Core references
›American Gastroenterological Association guideline on constipation 2013
›American College of Gastroenterology clinical guideline on chronic idiopathic constipation 2023
›Rome IV criteria for functional bowel disorders 2016
›American Society of Colon and Rectal Surgeons practice parameters for constipation 2016
›World Society of Emergency Surgery guidelines for acute colonic pseudo obstruction and volvulus 2017
Evidence & Review
Reviewed by SymptomDx Medical Team·Last reviewed
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.