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EncopresisFunctionalabdominalpainToilettrainingdifficultyRectalbleedingUTIWell ChildCheckConstipation

Gastroenterology

Constipation

2 templates in the library cover this condition: Constipation, follow-up and Constipation.

Worth reading together

EncopresisFunctional abdominal pain

Comes up in this visit

Toilet training difficultyRectal bleedingUTIWell Child Check

Template

Constipation, follow-up

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MonthChoose anyFirst line

StatusChoose oneFirst line

StoolsChoose one

ExamChoose one

AdherenceChoose one

HistoryChoose any

Medication planChoose one

Clean-outChoose any

Bowel careChoose any

Additional bowel careChoose any

Testing and referral statusChoose any

ReferralChoose one

Follow-upChoose one

Counseling

Constipation usually needs months of daily treatment, and stopping too early is the most common reason it comes back; the medicine is safe to use long term and is weaned slowly once stools stay soft. Recommended supportive care with an emphasis on daily toilet sits after meals, water, fruits and vegetables, and restarting the medicine if stools turn hard again. Return precautions given including belly pain that keeps getting worse, vomiting, blood in the stool, a swollen belly, no stool for several days despite the medicine, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with plan. Answered all questions.

What the sources cover

  • Stool pattern (soft, hard, loose, retention)
  • Adherence; stopping early
  • Continue maintenance for several months
  • Repeat cleanout; wean; toilet sits; reward chart; milk
  • GI and behavioral health referral
  • Follow-up default 3 months

Return precautions in the template

belly pain that keeps getting worsevomitingblood in the stoola swollen bellyno stool for several days despite the medicine

Sources

Template

Constipation

Tap a choice or type a Repertoire Line to see how the note changes. Defaults are what the template inserts on its own.

Practice wording only: leave out patient details. Nothing typed here is saved or sent.

AssessmentChoose any

FindingsChoose any

TestingChoose one

PlanChoose one

Add-onsChoose any

Additional counselingChoose any

ReferralChoose any

Follow-upChoose one

Follow-up reasonChoose anyJoins the line above

Counseling

If using medication, adjust the dose to get one or two soft stools a day; loose stools mean the dose can come down. Plan to continue it daily for at least 2 months, until stools have been soft and regular for at least a month, then wean slowly; it is safe to use for months. Recommended supportive care with an emphasis on a diet with fruits, vegetables, and whole grains, enough water, and, for toilet-trained children, sitting on the toilet for 5 minutes after meals once or twice a day with feet supported. Return precautions given including vomiting, belly swelling, blood in the stool, fever, no stool despite the medicine, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with plan. Answered all questions.

What the sources cover

  • Functional constipation by history and exam, no alarm features
  • Fecal impaction on exam
  • Retentive stool accidents (overflow incontinence)
  • Anal fissure
  • No labs or imaging needed
  • Abdominal x-ray because exam unreliable
  • Celiac and thyroid screening
  • Disimpaction with oral PEG then maintenance
  • Maintenance only (no impaction)
  • Enema clean-out
Show 15 more
  • Miralax or Lactulose or Milk of magnesia
  • Add Senna (stimulant)
  • Glycerin suppository as needed
  • Titrate to soft daily stools
  • ≥ 2 months, ≥ 1 month symptom-free before slow wean; continue through toilet training
  • Safety of long-term laxatives
  • Fiber, fruits, water, juice (prune/pear)
  • Scheduled toilet sits 1–2 times a day after meals (toilet-trained)
  • Explain withholding cycle or not a behavior problem
  • 2-week cow's-milk-free trial
  • Infant formula preparation checked
  • Referral to GI (alarm features or refractory)
  • Behavioral health referral
  • Follow up in 2-4 weeks
  • Return precautions (vomiting, distension, blood, fever, no stool)

Used to decide, kept out of the note

  • Alarm features (list)
  • No probiotics, teas, naturopathics

Return precautions in the template

vomitingbelly swellingblood in the stoolfeverno stool despite the medicine

Sources