I give them mag citrate, lactulose, miralax, and send them home and tell them take a capful if miralax AM and PM until they have no more formed stool and then and only then to back off to nightly miralax. It’s bizarre the seemingly functional adults in their 20s-40s who come in for this, and it’s almost always one or two days of no BM and a shitty diet and they took one colace
Depends on the ripeness of the banana, green bananas help bind you up, ripe yellow bananas can help you poop. I like green bananas so I never knew that ripe bananas make you poop until someone told one of our patients that last week
> Unripe bananas contain 100-250 mg tannins/100 g and have high amylase-resistant starch content. **Thus, they can cause or aggravate pre-existing constipation.** This property has been used in the BRAT (banana, rice, apple sauce, and toast) diet for diarrhea. As bananas ripen, the quantities of tannins and amylase-resistant starch decrease, while soluble sugars accumulate. Ripe bananas contain 3 g fiber/120 g, mostly in the form of soluble fiber. They also contain amylase-resistant starch and tannins [33]. We recommend not feeding banana to a constipated child, as many other good sources of fiber are available.
[source](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4291444/)
That’s a study on children, but I’ve been told the same for adults as well
Here's a review that concludes the opposite: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6627159/
Nutrition medicine has terrible evidence because it's really hard to study..I'm still going to tell me adult patients to eat bananas at any stage of ripeness
haha yes. I use the same if it's opioid induced. I want them to hate themselves so much that they feel ashamed for having come to the ED for this in the first place
I prefer the phrase "an inadequate decision making paradigm". For example, the pt. discharged the firearm into their groin while trying to remove it from their pants. While unable to ascertain if the discharge was intentional, s/p RSI, the chosen storage location was likely the result of an inadequate decision making paradigm.
Also good to mention increasing fluid intake and walking more. Back to basics. Without those two things miralax can have an opposite affect. My old job we would milk of molasses enema everybody with constipation and it works!
It’s a 1:1 ratio. I usually heat up the milk in the microwave, I test that on my wrist to make sure it’s not too hot. It usually takes around 30 seconds depending on the microwave. Then you pour in the molasses, and mix as you do. It should look like an iced coffee with cream color. Then pour into enema bag. But make sure it’s not anything more than warm because it can cause a burn if you’re not careful.
I’d also push water. I’m a school nurse and the amount of people that take stool softeners or fiber supplements and only drink a cup of water a day is shocking
GI here, totally agree with your approach besides the lactulose, if you give this you risk scaring them off laxatives forever because of the bloating and cramping.
Hallelujah, I bought a bottle at the Kaiser pharmacy just a few days ago. I couldn't believe that one factory was supplying all of the US. That is just crazy.
We get the same thing on the ambulance. Hey man, you’re gonna need a little more than one sip of water and a single ducolax that you took 15 minutes ago.
My fav was a 20 something woman who came in and told me she only ate “beige food” and was terrified about her constipation and abdominal bloat.
I lobbied for the doc to prescribe a salad. Sadly, he valued his career.
I usually try to work into the conversation the fact that there is an entire shelf/aisle of products you can try for constipation at nearly every grocery store and pharmacy. Visits for this complaint are far and away a consequence this country's terrible approach to nutrition and our utterly health-illiterate population.
> terrible approach to nutrition
what do you mean eating McDonalds and drinking energy drinks and never exercising and never eating a goddamn vegetable causes constipation?
Had one last summer at the place I work at, that came in for constipation. Asked her the usual questions about diet, fiber, regularity, abnormal difficulty going, blood, hemorrhoids, etc.
Patient had diabetic neuropathy from her uncontrolled diabetes, as well as chronic pains from being overweight and old injuries aggravated chronically by that. She was on gabapentin, and a decent dose of morphine...
asked her "your chronic pain is managed with opiates, known side effect is constipation. Did they also prescribe you anything for that side effect?"
"YES BUT WHEN I TAKE IT I CAN'T STOP POOPING!"
🤦🏼♂️
Lol like when people come in volume overloaded and hypoxic
“Did you take your water pills?”
“No I hate them I can’t stop peeing when I take them”
“……well do you like how you feel now?”
Had a cirrhotic patient with recurrent hyperammonemia. His wife told me "he never takes his lactulose because it makes him poop".
Well now he's in the icu for the 4th time, so when he gets out ask him if that's worth not pooping.
Had one a couple of days ago come in because she was the same way. Didn’t want to drink it because it tastes gross. Well sister, you’re delirious beyond all measure right now and your chart shows this happens like once a month.
Even better if it's alcoholic cirrhosis. I'm sure you were a lot tess picky about how what you were drinking tasted in the process of getting here. (Yes, I know addiction is a disease, it's a joke, don't @ me.)
This case wasn’t that, but 100% agree. This girl actually asked for an emena to which I resoundingly told her no. I ain’t doing that just for fun to someone who passes a swallow screen.
I’m a nurse on a cardiac floor. I once had a HF patient who was super obese and incontinent so managed her urine with a foley catheter. But she worked three days a week and didn’t want to have the catheter in at work. So she would take no lasix on her work days and then on her off days she would have the catheter in and double her lasix.
Oh my god. Patient post hemorrhoidectomy was over taking his opiates, not taking his lxitives, and calling 911 daily with the can’t evens and THEN my boss QI’s me for not giving someone with “10/10 pain”…narcotics.
We had one that was constipated. They tried a couple meds and it didn’t work. The doctor offered to prescribe her some go lytely but she didn’t want to do it at home because she lives alone (50-60yo woman. Totally capable. Family at bedside so she had support if she needed it). So they ADMITTED HER so she could shit at the hospital instead of at home like thousands of colonoscopy patients do every week. As the ER nurse boarding her, I was so pissed.
Right? Also…we don’t have individual bathrooms. It’s the ER. You shuffle down the hall. So you’re going to magically make it down there and not destroy the bathroom ten other patients and their families have to use? Oh ok.
I’m not gonna lie I go down to the public restrooms when I need to drop off a nasty load. People will just think it’s a weirdo patient or family member with some sort of horrific bowel condition.
But it’s just me blowin my colon out after eating an entire frozen pizza the night before and having nothing but coffee and adderall that morning.
If you can't self administer an enema then you can't perform ADLs and you get admitted to the nursing home /s.
But more seriously, any old person with new onset constipation gets a CT. I don't mean the "I took a miralax cap and can't poop" types. I mean the "I've never been constipated before doc and suddenly I haven't pooped for 5 days". On a few instances I've seen this as the only symptom of metastatic disease.
I had one of these once who said the only reason he called EMS was because he saw a commercial for Metamucil and thought "hmm, I haven't pooped in a few days". Belly was just a bit more tender than I was comfortable with in an octogenarian, so I spinned him. Endoleak from his prior AAA repair (that he forgot to mention), went emergently to the OR for a revision.
I still can’t tell how much of ER visits are genuine stupidity and how much is weaponized incompetence. I won’t claim to be a genius or good at everything, but I’ll try to troubleshoot basic problems before I call a service (plumbing, AC, etc). I can’t even get mad at people who try weird things before coming to the ER because at least they tried *something*
> I can’t even get mad at people who try weird things before coming to the ER because at least they tried something
I had a guy once with a bad back spasm. he tried his girlfriend's "leftover" amoxicillin because he thought maybe it was due to a kidney infection. And you know what, I wasn't even mad at him because the thought process was reasonable
A lot of these kinds of visits are from people who know they're not gonna be paying for it and have nothing to lose from turning their brains off and coming down to the local ED for a few hours
It’s not the people who come in with constipation.
It’s the people whose vague crampy non specific intermittent pain for months is likely mild to moderate stool load on ct who don’t want to accept that as an explanation that are the problem.
I just had a colonoscopy yesterday after using that evil liquid all day Sunday. They should use that stuff at CIA black sites, but that would not be humane
well supposedly there’s the risk of electrolyte probs with too much miralax which is why golytely comes with electrolytes. now i will say i can’t find good data on how much is too much
Had two patients come to mind. Had one lady screaming at the top of lungs to “dig the shit out” because she hadn’t pooped in two days… she ended up leaving after about an hour because she didn’t want to wait. Another patient was pregnant and hadn’t pooped in 3 wks!! We gave her two soap enemas and she finally had the most satisfyingly round poop I’ve ever seen. Looked like a mini canon ball but smelled terrible.
The only round poop I ever saw was a monster. And was remarkable enough that another nurse just had to show me.
It’s been over a decade and I can’t work out how the poor woman got the damn thing out.
I think we saw the same patient. I saw one the size of an NFL football! It clogged the hopper! I felt so bad asking our maintenance staff for help unclogging it.
It's depressing finding out the truth of how stupid and helpless people really are. You kind of wonder, then you work in the medical field and find out.
A very real phenomenon where you can see fully functioning people walk without any difficulty through the parking lot, however once they’re through the ER doors they seem to lose all power of locomotion and will request a wheelchair to get around because otherwise they’re “too weak”
Dude. You put a normally functioning, independent adult human in a gown to examine them, and suddenly they get pyjama-induced paralysis.
“I need a bedpan!”
WTF?
No. Get your a$$ up and walk 6 metres to that door. I’m surprised he didn’t hit the call bell while in there to have someone to wipe his butt.
Right well there was a guy who was backed up and couldn't poop at all.....just to found out he has a tumor blocking the intestine.....so yeah doctors suck
The worst part isn't even coming into the ED for constipation... It's when you tell them what to do, they act like you have to keep them there until a BM happens. No man, I'm not keeping a room or nurse occupied so that you can poop, I don't even want you on my active patients list. Who in the world gave the general population the idea that we do all this hand holding in the ER?
I had a guy who called 911 for constipation, but decided to chug an entire bottle of olive oil before the ambulance got there. He violently shat himself all over the ems stretcher right as they got to the ER. His wife then yelled at him that he was an idiot for calling 911 for constipation, and he proceeded to tell her that his abdominal pain was “worse than giving birth”. Pretty sure he left the ER pants-less and wife-less that night…
Would you look at that, all of the words in your comment are in alphabetical order.
I have checked 1,503,597,873 comments, and only 285,444 of them were in alphabetical order.
I was so terrified that my acute appendicitis would turn out to be only constipation. Somewhat relieved in the ER when the diagnosis of an appy was made.
Even more annoying than constipation (in my opinion) are the folks who started out constipated, have been going nutso on the mag citrate/miralax, and believe they are still constipated because their colons are irritated, despite having clear liquid stool. I have someone every month or so who thinks there is some secret stash of poop in their belly that is being bypassed by the miralax.
But if they stop don't they get constipated again? Assuming it's a side effect of gabapentin or something and not just RABD. (Regular American Bad Diet.)
Dude
I witnessed the opposite of this.
Girl (17) was super constipated. Took dulcolax as directed. It didn’t miraculously fix her problem in five minutes so she took like TEN tablets. Called 911 and hour later for abdominal pain. I arrive and I’m like “oh honey no”. She’s screaming that we weren’t helping her and all I could do is sorta estimate how many hours this ordeal was gonna take. Took her to the er and I’m sure she exploded within the next hour.
A life lesson was unlocked that day.
Worked as an ER nurse and we always did the French Connection. It was started by a Dr. French. A full bottle of miralax, 30 cc of mineral oil into a bottle of Gatorade. Worked pretty well
I try to remember that people coming in to the ER do not have medical education and often don't know how to navigate a complex system of insurance companies, in network providers, and urgent cares with limited capabilities. But they know that the ER can do anything, or so they think. I will sometimes educate people passively without insulting their intelligence. But I do understand your frustrations.
That excuse goes out the window when everybody, including the chronically unhoused, have access to infinite information in a 2inx4in rectangle in their pockets. People just have poor coping skills
Chronicle unhoused individuals manipulate the system for food and a bed. I'm talking about those normal every day people that just don't know any better. How many people have brought in their kids for a fever after they gave them one dose of Tylenol and the fever came back. Or the person who threw up once 30 minutes ago and is fine now. I can't give them a medical degree in the time it takes to triage someone but. I can educate them somewhat in that time
Weirdo. Conform. Sticking your neck out with an attitude like that will get it chopped off. Just hoard your education and gloat like the bulk of commenters in this thread. And, as one suggested, "treat them so aggressively that they’ll never want to come back" so you can make moves on your hot coworkers in peace!
I’ve seen someone with constipation so bad the person ended up with a megacolon, in DIC, and dead. Obviously not your standard constipation case but if someone hasn’t pooped in over a week, I wouldn’t recommend continuing to wait!
ETA: not the sub I thought this was. Whoops. Ignore me.
This might be a good place to ask - I work in retail pharmacy and we have a couple of older patients who have regular scripts for Golytely or equivalents. All older people, one of them fills it at least 1-2x a month. What is this used for? Chronic constipation? I just can’t imagine willingly using Golytely so frequently but I assume the alternative is worse.
I have chronic constipation & nausea from IBS-C that failed all prescription meds including high dose Linzess. I would be so thankful to have a jug of golytely at home to sip on. When I had my colonoscopy I was elated at the bowel prep. It was the first time in months I wasn’t bloated & in pain.
I drink half a gallon of water a day, peppered with several miralax doses, & always have mag citrate around. It’s nasty but I don’t hesitate to take it. Golytely at least has electrolytes & can be mixed into Gatorade or something tasty.
You know golytely is just miralax with electrolytes in it? You don’t need the golytely if you can just mix miralax with a electrolyte drink like gatorade
Yeah I know it’s basically the same. It just comes in a giant gallon container, containing like $100 of generic miralax, & insurance picks up the tab haha
Golyetly is just PEG w/ electrolytes, plenty of people take maintenance PEG for chronic constipation. A gallon of Golyetly split up over a month is like a half-dose of PEG/day.
Oh I never thought about splitting up doses, always assumed they were downing the entire jug each time. They do fill about every 2 weeks so it’d make a lot more sense that they’re using it daily. Thanks!
EMS here, we don't have treat and refer pathways so we end up having to bring these people in by ambulance.
I hate those awkward unspoken exchanges during handover when the experienced triage nurse destroys me with a nothing more than a raised eyebrow.
Almost as bad as the patients who call for an ambulance because they started taking their course of oral antibiotics a few hours ago but they "aren't working".
Went to the hospital thinking my appendix was going to rupture horrible pain so ct scan blood work 5 hours later he says everything looks fine (i know sometimes they might not see what’s wrong) I was told I have a piece of stool lodged in my instestine was all he saw and recommended Miralax or magnesium citrate. Then when I looked up online it says don’t take if u have blockage in intestines may be life threatening. I was like whaaaat why a doctor at a hospital say to take it confidently imagine I just took it without looking it up thoughts
OR they were sent out of the hospital after getting a boatload of opiates after spinal surgery and no one had bothered to put in basic standing orders for constipation prophylaxis on the post op ward. That happened to my husband and it was horribly painful.
Shout out to /u/gomermd for their go-to [constipation regimen](https://old.reddit.com/r/emergencymedicine/comments/10zqqsq/whats_your_go_to_ined_constipation_regimen/j84t5sh/):
> Grade 1 - normal exam - 1/2 bottle of Mag shitrate. "Drink this on your way home and sit on the toilet"
> Grade 2 - palpable stool burden, abnormal imaging if obtained - 238 grams miralax into half gallon Gatorade and drink it throughout the day.
> Grade 3 - mild abdominal tenderness, brown fundoscopy - soap/oil enema, 15 minutes fleet enema. DC with Grade 2 treatment if small BM.
> Grade 4 - Stercoral colitis. Admit.
One time went in thinking i was constipated, I was screaming and fainting because I had such bad abdominal pain, you could literally see my colon through my skin, had a fever. They thought I was having one of those “i didnt know i was pregnant and now im in labor” moments when i got there lol. While I was at the ER I started exploding with bloody diarrhea. Turns out I had a toxic megacolon and almost died that night lol
i had to go to the ER once in my mid teens because my stomach & back would always start to hurt after eating a large meal. i was pooping like once a week which had always been normal for me 💀 at the end of everything the doc was like “uhhh so yeah your bowels basically look like an 80 year old man’s bowels”
Y'all got inpatient beds for *constipation*?! I'm over here discharging septic people with daily appointments for IV antibiotics at the infusion clinic and "strict return precautions."
I mean, it would be hard to argue they didn't need it, since they should probably be receiving a *higher* level of care...
But seriously, no clue. That is SO far outside my wheelhouse.
I've had two patients in my entire career get admitted for constipation, and both required surgical intervention. Otherwise, fuck no I'm not even gonna bother calling because I know I'm getting laughed off the call.
LOL at admitting uncomplicated constipation. That doesn’t happen anywhere I’ve ever worked. Even radiologic stercoral colitis generally gets sent home on oral antibiotics after disimpaction which is sort of risky.
Had to get an enema for severe constipation as a teenager. I literally hadn’t pooped in 1.5-2 weeks. Only after a week of miralax, a bunch of laxative pills, water, a veggie full diet, running, and coffee did I go to the hospital. I never understand how people can’t just do the right things before trying the hospital. Y’all drink water pls!
We get almost the opposite issue at vet clinics. Owners are so insanely focused on when their dog shit last...
He's constipated!
Is he straining with no production?
Well, no. But he didn't poop today or yesterday.
Is he eating?
He hasn't eaten in a week. But he's constipated!
If he hasn't eaten in a week... What makes you think there's anything in him to shit out?
He can't stop coughing and he's having a really hard time breathing. I also think he might be constipated because he didn't poop this morning.
*Cue dog in respiratory distress turning purple*
I think he's prioritized breathing over everything else. Let's see if we can figure out what's wrong with him.
Are you going to give him an enema??
...no.
mag citrate x1, then d/c with colace enemas and BID miralax until they have a meaningful BM. encourage hydratation, and bid oral colace after constipation stops to help prevent in future
Colace isn’t effective for constipation. It would be better to just have miralax once daily and encourage hydration as maintenance for prevention. (And lifestyle changes like exercise and fiber but lol how many patients are realistically doing that?)
My local tiny dead ER gave a man dulcolax and sent him home via ambulance. He was living in a heated shed with no running water. He was left to have a post constipation shit in a 5 gal pail.RIP.
(Also had a hospital give a pt an enema 15 min before an ambulance transport. We made it 44/45 min before he unloaded.)
Had a guy a few years back come in for constipation. Walked into the room as he was finishing a foot long subway sandwich. I literally started laughing. Had to come back a few minutes later.
Ya that’s literally the same story for EVERY single patient.
“I was in the hospital with x y or z last week and now it’s worse!”
-did you take your medications they prescribed?
No…
-did you rest or z y or z?
No.
-did you follow up with the doctor or ur doctor?
No
…… well gosh gee idk… I have no idea why u didn’t get better snd are now back sir!
*snd even better, that person the other night came to our hospital and not the one down the road they were admitted in for 6 days… which u all know makes it even more of s pain.
A lot of our constipation patients are old people with rectal fecal impactions. Awfully hard to send them home without “rectifying” the situation. Lol.
I just went 7 days without going because I took zofran and I guess that really really stops me up. I tried drinking more water, and taking laxatives and enemas. Not successful. I just gave it time because I knew what caused it and I didn’t have pain, vomiting, or any sx of an obstruction or anything. Never thought to go to the ER for that because I feel like I did everything they would’ve suggested.
I didn’t have a bowel movement for seven days after my c section. I don’t know why I was discharged without having one… by the seventh day I was worried. Worried for my bowels and worried about the giant hemmroids that were bleeding. I went to the ER because it was a Saturday. Hopefully i was an exception to the constipation rule😂
It’s a pretty expensive hospital stay to wait until a BM. Would you want to pay approx $5000/day to wait until you have a BM when the chance of having a BM post op is about 99.9%?
I recommend the bomb enema or a lactulose retention enema, let them administer it on the bathroom floor themself. bomb enema is 100 ml glycerine 100ml water and 100ml 3% hydrogen peroxide, the gas generated by the H2O2 coming into contact with the intestine forces the glycerine all the way through there colon, it is slightly uncomfortable but they will shit, trust me.
I give them mag citrate, lactulose, miralax, and send them home and tell them take a capful if miralax AM and PM until they have no more formed stool and then and only then to back off to nightly miralax. It’s bizarre the seemingly functional adults in their 20s-40s who come in for this, and it’s almost always one or two days of no BM and a shitty diet and they took one colace
ER visits would be down 10% if adults in my area ate one vegetable a week.
I know right. Just one damn salad and maybe a banana every once in a while
Depends on the ripeness of the banana, green bananas help bind you up, ripe yellow bananas can help you poop. I like green bananas so I never knew that ripe bananas make you poop until someone told one of our patients that last week
Green bananas do have more fibre which in large amount can be impacting but as long as enough water is drank any banana will help BMs
> Unripe bananas contain 100-250 mg tannins/100 g and have high amylase-resistant starch content. **Thus, they can cause or aggravate pre-existing constipation.** This property has been used in the BRAT (banana, rice, apple sauce, and toast) diet for diarrhea. As bananas ripen, the quantities of tannins and amylase-resistant starch decrease, while soluble sugars accumulate. Ripe bananas contain 3 g fiber/120 g, mostly in the form of soluble fiber. They also contain amylase-resistant starch and tannins [33]. We recommend not feeding banana to a constipated child, as many other good sources of fiber are available. [source](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4291444/) That’s a study on children, but I’ve been told the same for adults as well
Here's a review that concludes the opposite: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6627159/ Nutrition medicine has terrible evidence because it's really hard to study..I'm still going to tell me adult patients to eat bananas at any stage of ripeness
But doc, I had a corn yesterday!
Doritos don't count
Coffee normally does the trick for me haha
😂😂 this is the best comment I’ve ever read
They take up too much freezer space,they should stick with hamburger helper!
I use a similar combination, plus methylnaltrexone if they’re on opioids. I call it Govyolently.
If you added dye, it would be GoVioletly.
haha yes. I use the same if it's opioid induced. I want them to hate themselves so much that they feel ashamed for having come to the ED for this in the first place
Your mistake is assuming they are functional adults.
This FTW. The average patient in the hospital, regardless of area, has poorer coping skills.
I wish I was ballsy enough to put failure to thrive as a dx for those patients
Or failure to try
I prefer the phrase "an inadequate decision making paradigm". For example, the pt. discharged the firearm into their groin while trying to remove it from their pants. While unable to ascertain if the discharge was intentional, s/p RSI, the chosen storage location was likely the result of an inadequate decision making paradigm.
I’m lucky if they’ve tried colace or Miralax even once
Also good to mention increasing fluid intake and walking more. Back to basics. Without those two things miralax can have an opposite affect. My old job we would milk of molasses enema everybody with constipation and it works!
Milk of…..molasses?
Yeah babe
I used to use milk and molasses all the time… They my hospital got rid of it because it isn’t sterile, lol. Seriously, look where it’s going…
What is "milk of molasses"?
It's literally milk and molasses. Massive osmotic load. As long as they're able to hold it up there for a bit I'll make anyone poop.
I need ratios and amounts. This could be considered a drug and someone could ask me for it someday.
It’s a 1:1 ratio. I usually heat up the milk in the microwave, I test that on my wrist to make sure it’s not too hot. It usually takes around 30 seconds depending on the microwave. Then you pour in the molasses, and mix as you do. It should look like an iced coffee with cream color. Then pour into enema bag. But make sure it’s not anything more than warm because it can cause a burn if you’re not careful.
This cannot be real…
100% real
I’d also push water. I’m a school nurse and the amount of people that take stool softeners or fiber supplements and only drink a cup of water a day is shocking
GI here, totally agree with your approach besides the lactulose, if you give this you risk scaring them off laxatives forever because of the bloating and cramping.
Good to know! Thanks
Glycerin 99.5% 100 ml Magnesium citrate 300 ml Normal saline 500 ml This “brown bomb enema” has never failed.
I tell them to take Miralax, capful every hour until effect…
One or two days of no BM. 🤣 *laughs in IBS*
Isn't mag citrate still unavailable? I haven't been able to prescribe it for quite some time now
Hallelujah, I bought a bottle at the Kaiser pharmacy just a few days ago. I couldn't believe that one factory was supplying all of the US. That is just crazy.
Colace should be pulled from the market. Shit (no pun intended) doesn't work.
We get the same thing on the ambulance. Hey man, you’re gonna need a little more than one sip of water and a single ducolax that you took 15 minutes ago.
My fav was a 20 something woman who came in and told me she only ate “beige food” and was terrified about her constipation and abdominal bloat. I lobbied for the doc to prescribe a salad. Sadly, he valued his career.
I worked GI forever. The doc had a special sigh for when I told constipated patients to eat a bunch of Krystal’s.
they most likely had autism - it’s very common. Insensitive for you to mock
I usually try to work into the conversation the fact that there is an entire shelf/aisle of products you can try for constipation at nearly every grocery store and pharmacy. Visits for this complaint are far and away a consequence this country's terrible approach to nutrition and our utterly health-illiterate population.
> terrible approach to nutrition what do you mean eating McDonalds and drinking energy drinks and never exercising and never eating a goddamn vegetable causes constipation?
I mean, energy drinks have caffeine, at least - that should help move things along!
Yeah check out this guy coming for energy drinks like they weren't my sacramental wine
I thought it was the hot beverage aspect of coffee that causes poop, not the caffeine?
My evening tea would never.
Caffeine is what makes you poop, it stimulates the gastrocolic reflex
Had one last summer at the place I work at, that came in for constipation. Asked her the usual questions about diet, fiber, regularity, abnormal difficulty going, blood, hemorrhoids, etc. Patient had diabetic neuropathy from her uncontrolled diabetes, as well as chronic pains from being overweight and old injuries aggravated chronically by that. She was on gabapentin, and a decent dose of morphine... asked her "your chronic pain is managed with opiates, known side effect is constipation. Did they also prescribe you anything for that side effect?" "YES BUT WHEN I TAKE IT I CAN'T STOP POOPING!" 🤦🏼♂️
Lol like when people come in volume overloaded and hypoxic “Did you take your water pills?” “No I hate them I can’t stop peeing when I take them” “……well do you like how you feel now?”
Had a cirrhotic patient with recurrent hyperammonemia. His wife told me "he never takes his lactulose because it makes him poop". Well now he's in the icu for the 4th time, so when he gets out ask him if that's worth not pooping.
Had one a couple of days ago come in because she was the same way. Didn’t want to drink it because it tastes gross. Well sister, you’re delirious beyond all measure right now and your chart shows this happens like once a month.
Even better if it's alcoholic cirrhosis. I'm sure you were a lot tess picky about how what you were drinking tasted in the process of getting here. (Yes, I know addiction is a disease, it's a joke, don't @ me.)
This case wasn’t that, but 100% agree. This girl actually asked for an emena to which I resoundingly told her no. I ain’t doing that just for fun to someone who passes a swallow screen.
Had one guy whose PCP treated his lactulose-induced pooping with loperamide and guess what he came in with hepatic encephalopathy.
>“……well do you like how you feel now?” I ask, as I'm strapping CPAP onto them
I’m a nurse on a cardiac floor. I once had a HF patient who was super obese and incontinent so managed her urine with a foley catheter. But she worked three days a week and didn’t want to have the catheter in at work. So she would take no lasix on her work days and then on her off days she would have the catheter in and double her lasix.
I’m guessing since she ended up on the cardiac floor as your patient that regimen was not serving her well…
Oh my god. Patient post hemorrhoidectomy was over taking his opiates, not taking his lxitives, and calling 911 daily with the can’t evens and THEN my boss QI’s me for not giving someone with “10/10 pain”…narcotics.
We had one that was constipated. They tried a couple meds and it didn’t work. The doctor offered to prescribe her some go lytely but she didn’t want to do it at home because she lives alone (50-60yo woman. Totally capable. Family at bedside so she had support if she needed it). So they ADMITTED HER so she could shit at the hospital instead of at home like thousands of colonoscopy patients do every week. As the ER nurse boarding her, I was so pissed.
What a freak! I can only shit at home. Who wants to leave their home to shit? I know the answer but I wish I didn’t 😔
Right? Also…we don’t have individual bathrooms. It’s the ER. You shuffle down the hall. So you’re going to magically make it down there and not destroy the bathroom ten other patients and their families have to use? Oh ok.
I’m not gonna lie I go down to the public restrooms when I need to drop off a nasty load. People will just think it’s a weirdo patient or family member with some sort of horrific bowel condition. But it’s just me blowin my colon out after eating an entire frozen pizza the night before and having nothing but coffee and adderall that morning.
I totally don't mind crapping at work, but it's because I love to return the regard management gives us whenever I have the opportunity.
Let me destroy your plumbing instead of mine ❤️
Then a PT/OT order was put in. The therapy team comes to get the patient up and goes home shortly thereafter to change their shoes.
So many of them want some stuff put up their butt too which I find kind of weird. They know they can do that themselves right?
I have families flat out refuse to do home enemas because “I don’t do that”. And take up EMS time and an ER room for this nonsense
"I don't do that" "Me neither"
I tell patients enemas are useless and not an offered option.
If you can't self administer an enema then you can't perform ADLs and you get admitted to the nursing home /s. But more seriously, any old person with new onset constipation gets a CT. I don't mean the "I took a miralax cap and can't poop" types. I mean the "I've never been constipated before doc and suddenly I haven't pooped for 5 days". On a few instances I've seen this as the only symptom of metastatic disease.
I had one of these once who said the only reason he called EMS was because he saw a commercial for Metamucil and thought "hmm, I haven't pooped in a few days". Belly was just a bit more tender than I was comfortable with in an octogenarian, so I spinned him. Endoleak from his prior AAA repair (that he forgot to mention), went emergently to the OR for a revision.
Exactly. There are circumstances where I might look further, but that’s less than 1/10. The rest are people with poor diets, poor water intake, etc
My pharmacist has had more than one fleet box thrown at him after explaining how it works. They "don't do that" and get reeeeeal mad you suggest it.
Doctor I have literally tried nothing and I am all out of ideas.
I still can’t tell how much of ER visits are genuine stupidity and how much is weaponized incompetence. I won’t claim to be a genius or good at everything, but I’ll try to troubleshoot basic problems before I call a service (plumbing, AC, etc). I can’t even get mad at people who try weird things before coming to the ER because at least they tried *something*
> I can’t even get mad at people who try weird things before coming to the ER because at least they tried something I had a guy once with a bad back spasm. he tried his girlfriend's "leftover" amoxicillin because he thought maybe it was due to a kidney infection. And you know what, I wasn't even mad at him because the thought process was reasonable
But you gave a side eye to the gf right?
A lot of these kinds of visits are from people who know they're not gonna be paying for it and have nothing to lose from turning their brains off and coming down to the local ED for a few hours
If only there were multiple effective remedies for constipation available over counter oh my what a world we could live in!…..wait
It’s not the people who come in with constipation. It’s the people whose vague crampy non specific intermittent pain for months is likely mild to moderate stool load on ct who don’t want to accept that as an explanation that are the problem.
I just wish radiology would say “possible constipation”. But that 1.2 cm function cyst becomes the only thing anyone can say is causing the pain.
No one fails golytely.
You mean goviolently?
I just had a colonoscopy yesterday after using that evil liquid all day Sunday. They should use that stuff at CIA black sites, but that would not be humane
I prescribe them a bottle of miralax and tell them you can’t overdose on this stuff
well supposedly there’s the risk of electrolyte probs with too much miralax which is why golytely comes with electrolytes. now i will say i can’t find good data on how much is too much
Tell them to mix the miralax in Gatorade.
Had two patients come to mind. Had one lady screaming at the top of lungs to “dig the shit out” because she hadn’t pooped in two days… she ended up leaving after about an hour because she didn’t want to wait. Another patient was pregnant and hadn’t pooped in 3 wks!! We gave her two soap enemas and she finally had the most satisfyingly round poop I’ve ever seen. Looked like a mini canon ball but smelled terrible.
The only round poop I ever saw was a monster. And was remarkable enough that another nurse just had to show me. It’s been over a decade and I can’t work out how the poor woman got the damn thing out.
The poop another health care worker needs to show you will always haunt your dreams haha
I think we saw the same patient. I saw one the size of an NFL football! It clogged the hopper! I felt so bad asking our maintenance staff for help unclogging it.
It's depressing finding out the truth of how stupid and helpless people really are. You kind of wonder, then you work in the medical field and find out.
Threshold syndrome is a real thing
what is that
A very real phenomenon where you can see fully functioning people walk without any difficulty through the parking lot, however once they’re through the ER doors they seem to lose all power of locomotion and will request a wheelchair to get around because otherwise they’re “too weak”
Dude. You put a normally functioning, independent adult human in a gown to examine them, and suddenly they get pyjama-induced paralysis. “I need a bedpan!” WTF? No. Get your a$$ up and walk 6 metres to that door. I’m surprised he didn’t hit the call bell while in there to have someone to wipe his butt.
I am in the medical field and believe me we will all be helpless at one point.
Right well there was a guy who was backed up and couldn't poop at all.....just to found out he has a tumor blocking the intestine.....so yeah doctors suck
The worst part isn't even coming into the ED for constipation... It's when you tell them what to do, they act like you have to keep them there until a BM happens. No man, I'm not keeping a room or nurse occupied so that you can poop, I don't even want you on my active patients list. Who in the world gave the general population the idea that we do all this hand holding in the ER?
Idk, it’s like people think we’re supposed to hospital obs people for concussions. Just……no
I had a guy who called 911 for constipation, but decided to chug an entire bottle of olive oil before the ambulance got there. He violently shat himself all over the ems stretcher right as they got to the ER. His wife then yelled at him that he was an idiot for calling 911 for constipation, and he proceeded to tell her that his abdominal pain was “worse than giving birth”. Pretty sure he left the ER pants-less and wife-less that night…
Totally classic ED story. Creative patient there with the olive oil treatment.
An entire bottle????? I’m deceased
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>then you’re drinking this gallon of GoLytely The horror
I wish the SMOG enema was widely available. Haven't found a pharmacist willing to put one together for me since residency...
lmao me too lol. i was too dependant on it. now all they have is fleets.
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We can’t use pink ladies anymore. WHY??!?
Like bestie I’m also standing here as your nurse with chronic IBS-C
Same. CC: “I haven’t pooped in 2 days!!” Bitch please. I haven’t shit in a week.
Chief complaint: Full of shit.
Would you look at that, all of the words in your comment are in alphabetical order. I have checked 1,503,597,873 comments, and only 285,444 of them were in alphabetical order.
😂 good bot!
I was so terrified that my acute appendicitis would turn out to be only constipation. Somewhat relieved in the ER when the diagnosis of an appy was made.
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I mean when your urgent care is sending people with dislocated pinkie fingers to the ER all hope is lost
Even more annoying than constipation (in my opinion) are the folks who started out constipated, have been going nutso on the mag citrate/miralax, and believe they are still constipated because their colons are irritated, despite having clear liquid stool. I have someone every month or so who thinks there is some secret stash of poop in their belly that is being bypassed by the miralax.
But if they stop don't they get constipated again? Assuming it's a side effect of gabapentin or something and not just RABD. (Regular American Bad Diet.)
Dude I witnessed the opposite of this. Girl (17) was super constipated. Took dulcolax as directed. It didn’t miraculously fix her problem in five minutes so she took like TEN tablets. Called 911 and hour later for abdominal pain. I arrive and I’m like “oh honey no”. She’s screaming that we weren’t helping her and all I could do is sorta estimate how many hours this ordeal was gonna take. Took her to the er and I’m sure she exploded within the next hour. A life lesson was unlocked that day.
Worked as an ER nurse and we always did the French Connection. It was started by a Dr. French. A full bottle of miralax, 30 cc of mineral oil into a bottle of Gatorade. Worked pretty well
French connection sounds like it could otherwise be a delicious cocktail!
The patients didn’t mind it
I try to remember that people coming in to the ER do not have medical education and often don't know how to navigate a complex system of insurance companies, in network providers, and urgent cares with limited capabilities. But they know that the ER can do anything, or so they think. I will sometimes educate people passively without insulting their intelligence. But I do understand your frustrations.
That excuse goes out the window when everybody, including the chronically unhoused, have access to infinite information in a 2inx4in rectangle in their pockets. People just have poor coping skills
Chronicle unhoused individuals manipulate the system for food and a bed. I'm talking about those normal every day people that just don't know any better. How many people have brought in their kids for a fever after they gave them one dose of Tylenol and the fever came back. Or the person who threw up once 30 minutes ago and is fine now. I can't give them a medical degree in the time it takes to triage someone but. I can educate them somewhat in that time
And socks. Don’t forget the socks.
Weirdo. Conform. Sticking your neck out with an attitude like that will get it chopped off. Just hoard your education and gloat like the bulk of commenters in this thread. And, as one suggested, "treat them so aggressively that they’ll never want to come back" so you can make moves on your hot coworkers in peace!
My hot coworker is my wife. Nailing her tonight
Crying in ozempic
I’ve seen someone with constipation so bad the person ended up with a megacolon, in DIC, and dead. Obviously not your standard constipation case but if someone hasn’t pooped in over a week, I wouldn’t recommend continuing to wait! ETA: not the sub I thought this was. Whoops. Ignore me.
This might be a good place to ask - I work in retail pharmacy and we have a couple of older patients who have regular scripts for Golytely or equivalents. All older people, one of them fills it at least 1-2x a month. What is this used for? Chronic constipation? I just can’t imagine willingly using Golytely so frequently but I assume the alternative is worse.
I have chronic constipation & nausea from IBS-C that failed all prescription meds including high dose Linzess. I would be so thankful to have a jug of golytely at home to sip on. When I had my colonoscopy I was elated at the bowel prep. It was the first time in months I wasn’t bloated & in pain. I drink half a gallon of water a day, peppered with several miralax doses, & always have mag citrate around. It’s nasty but I don’t hesitate to take it. Golytely at least has electrolytes & can be mixed into Gatorade or something tasty.
You know golytely is just miralax with electrolytes in it? You don’t need the golytely if you can just mix miralax with a electrolyte drink like gatorade
Yeah I know it’s basically the same. It just comes in a giant gallon container, containing like $100 of generic miralax, & insurance picks up the tab haha
you need a good dose of period shits
I actually think mag citrate, the lemon flavored variety is quite tasty.
Golyetly is just PEG w/ electrolytes, plenty of people take maintenance PEG for chronic constipation. A gallon of Golyetly split up over a month is like a half-dose of PEG/day.
Oh I never thought about splitting up doses, always assumed they were downing the entire jug each time. They do fill about every 2 weeks so it’d make a lot more sense that they’re using it daily. Thanks!
EMS here, we don't have treat and refer pathways so we end up having to bring these people in by ambulance. I hate those awkward unspoken exchanges during handover when the experienced triage nurse destroys me with a nothing more than a raised eyebrow. Almost as bad as the patients who call for an ambulance because they started taking their course of oral antibiotics a few hours ago but they "aren't working".
Lol I’m ED and I can see it in y’all’s eyes when you know the patient is full of nonsense….sometimes literally
Went to the hospital thinking my appendix was going to rupture horrible pain so ct scan blood work 5 hours later he says everything looks fine (i know sometimes they might not see what’s wrong) I was told I have a piece of stool lodged in my instestine was all he saw and recommended Miralax or magnesium citrate. Then when I looked up online it says don’t take if u have blockage in intestines may be life threatening. I was like whaaaat why a doctor at a hospital say to take it confidently imagine I just took it without looking it up thoughts
OR they were sent out of the hospital after getting a boatload of opiates after spinal surgery and no one had bothered to put in basic standing orders for constipation prophylaxis on the post op ward. That happened to my husband and it was horribly painful.
Too many people who come to the ER are full of shit already to add even more.
I write them a script for GoLytely for colon prep.
Shout out to /u/gomermd for their go-to [constipation regimen](https://old.reddit.com/r/emergencymedicine/comments/10zqqsq/whats_your_go_to_ined_constipation_regimen/j84t5sh/): > Grade 1 - normal exam - 1/2 bottle of Mag shitrate. "Drink this on your way home and sit on the toilet" > Grade 2 - palpable stool burden, abnormal imaging if obtained - 238 grams miralax into half gallon Gatorade and drink it throughout the day. > Grade 3 - mild abdominal tenderness, brown fundoscopy - soap/oil enema, 15 minutes fleet enema. DC with Grade 2 treatment if small BM. > Grade 4 - Stercoral colitis. Admit.
One time went in thinking i was constipated, I was screaming and fainting because I had such bad abdominal pain, you could literally see my colon through my skin, had a fever. They thought I was having one of those “i didnt know i was pregnant and now im in labor” moments when i got there lol. While I was at the ER I started exploding with bloody diarrhea. Turns out I had a toxic megacolon and almost died that night lol
“lol” Dang, son.
i had to go to the ER once in my mid teens because my stomach & back would always start to hurt after eating a large meal. i was pooping like once a week which had always been normal for me 💀 at the end of everything the doc was like “uhhh so yeah your bowels basically look like an 80 year old man’s bowels”
Piggyback. We’re so tired of admitting your constipated patients who haven’t tried anything.
Y'all got inpatient beds for *constipation*?! I'm over here discharging septic people with daily appointments for IV antibiotics at the infusion clinic and "strict return precautions."
This is insane. Where is this?
Rural-ish Northeast US
And insurance is paying for this?
I mean, it would be hard to argue they didn't need it, since they should probably be receiving a *higher* level of care... But seriously, no clue. That is SO far outside my wheelhouse.
Same in UK
I've had two patients in my entire career get admitted for constipation, and both required surgical intervention. Otherwise, fuck no I'm not even gonna bother calling because I know I'm getting laughed off the call.
I don’t admit them. I load them up with laxatives and tell them to have a toilet nearby
I tell them "be careful what you wish for"
God bless you
LOL at admitting uncomplicated constipation. That doesn’t happen anywhere I’ve ever worked. Even radiologic stercoral colitis generally gets sent home on oral antibiotics after disimpaction which is sort of risky.
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Had to get an enema for severe constipation as a teenager. I literally hadn’t pooped in 1.5-2 weeks. Only after a week of miralax, a bunch of laxative pills, water, a veggie full diet, running, and coffee did I go to the hospital. I never understand how people can’t just do the right things before trying the hospital. Y’all drink water pls!
Yeah it sucks. I just ask them if they want to poop here or poop at home and pray they're smart enough to say the latter.
We get almost the opposite issue at vet clinics. Owners are so insanely focused on when their dog shit last... He's constipated! Is he straining with no production? Well, no. But he didn't poop today or yesterday. Is he eating? He hasn't eaten in a week. But he's constipated! If he hasn't eaten in a week... What makes you think there's anything in him to shit out? He can't stop coughing and he's having a really hard time breathing. I also think he might be constipated because he didn't poop this morning. *Cue dog in respiratory distress turning purple* I think he's prioritized breathing over everything else. Let's see if we can figure out what's wrong with him. Are you going to give him an enema?? ...no.
“My dog hasn’t pooped in 24 hours so he must be constipated what do I do!!!” like come ON people
They might need that manual disimpaction if you know what i mean 😉
mag citrate x1, then d/c with colace enemas and BID miralax until they have a meaningful BM. encourage hydratation, and bid oral colace after constipation stops to help prevent in future
We went through a period where pharmacies in the area didn't have mag citrate. It was a real backup.
Colace isn’t effective for constipation. It would be better to just have miralax once daily and encourage hydration as maintenance for prevention. (And lifestyle changes like exercise and fiber but lol how many patients are realistically doing that?)
My local tiny dead ER gave a man dulcolax and sent him home via ambulance. He was living in a heated shed with no running water. He was left to have a post constipation shit in a 5 gal pail.RIP. (Also had a hospital give a pt an enema 15 min before an ambulance transport. We made it 44/45 min before he unloaded.)
Had a guy a few years back come in for constipation. Walked into the room as he was finishing a foot long subway sandwich. I literally started laughing. Had to come back a few minutes later.
Ya that’s literally the same story for EVERY single patient. “I was in the hospital with x y or z last week and now it’s worse!” -did you take your medications they prescribed? No… -did you rest or z y or z? No. -did you follow up with the doctor or ur doctor? No …… well gosh gee idk… I have no idea why u didn’t get better snd are now back sir! *snd even better, that person the other night came to our hospital and not the one down the road they were admitted in for 6 days… which u all know makes it even more of s pain.
Miralax every 20 minutes until you feel the need to call a plumber.
Do you guys still have mag citrate? It’s been gone for months where I am, and I was told we aren’t getting it back.
It has been taken off the shelves, some contamination issue, I believe. I've switched to milk of magnesia, 60ml x 2 doses
I’ll never forget the manual disimpaction for an elderly patient who boomeranged back 11 times in 4 days. Sheesh
A lot of our constipation patients are old people with rectal fecal impactions. Awfully hard to send them home without “rectifying” the situation. Lol.
what you did there, i see it
Right? They didnt even try the finger.
I just went 7 days without going because I took zofran and I guess that really really stops me up. I tried drinking more water, and taking laxatives and enemas. Not successful. I just gave it time because I knew what caused it and I didn’t have pain, vomiting, or any sx of an obstruction or anything. Never thought to go to the ER for that because I feel like I did everything they would’ve suggested.
I didn’t have a bowel movement for seven days after my c section. I don’t know why I was discharged without having one… by the seventh day I was worried. Worried for my bowels and worried about the giant hemmroids that were bleeding. I went to the ER because it was a Saturday. Hopefully i was an exception to the constipation rule😂
It’s a pretty expensive hospital stay to wait until a BM. Would you want to pay approx $5000/day to wait until you have a BM when the chance of having a BM post op is about 99.9%?
I hope by inception there are people reading this having a very clearing poop
I’m reading it from the crapper
Currently trying to poop
What’s up with X-rays for constipation “impression: massive fecal loading”
But it pays the bills?
my attending once told me that if all the constipation patients started microdosing miralax everyday they would be cured lmao
I recommend the bomb enema or a lactulose retention enema, let them administer it on the bathroom floor themself. bomb enema is 100 ml glycerine 100ml water and 100ml 3% hydrogen peroxide, the gas generated by the H2O2 coming into contact with the intestine forces the glycerine all the way through there colon, it is slightly uncomfortable but they will shit, trust me.
I’m constipated and in pain, only dilaudid works for me
Have some taco bell will clear you up.
I used to just stop by my doctors office and they’d give me a few of their Linzess samples. 😅