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