Constipation
Definition
Functional constipation (no organic etiology) needs at least TWO of following:
At least 2 stools or fewer per week
Incontinence at least once per week
Hx of excessive stool retention
Hx of painful or hard stools
Presence of large fecal mass in rectum
History of large stools that may block the toilet
Definition of fecal impaction: A hard mass in the lower abdomen identified on physical examination or a dilated rectum filled with a large amount of stool on rectal examination or excessive stool in the distal colon on abdominal radiography.
Documentation Supporting Medical Necessity For Hospitalization
Presence of fecal impaction
Failed outpatient laxative
Failed outpatient enema
No stool for at least 7 days
Presence of encopresis
Abdominal pain
Nausea and vomiting
Need for cleanout with polyethylene glycol (includes PO)
Organic Constipation
Constipation attributed to a medical condition. Present in <5% of kids with constipation.
Alarm symptoms suggesting organic cause of constipation:
Delayed passage of meconium
Fever with vomiting, diarrhea
Rectal bleeding (unless due to anal fissure)
Severe abdominal distention
Urinary incontinence
Weight loss or poor weight gain
Delayed growth
Neurologic symptoms
Sacral spine anomalies