Lower GI

Question 1

how do we classify someone of having chronic idiopathic constipation?

Answer 1

-straining during 25% or more of defecations
-lumpy/hard stool 25%
-incomplete evacuation 25%
-obstruction/blockage 25%
-less than 3 spontaneous bowel movements per week

Question 2

when would we consider pt having chronic idiopathic constipation over IBS?

Answer 2

no abdominal pain

Question 3

how do we treat IBS constipation?

Answer 3

first-line for constipation: osmotic laxatives (PEG)
first-line for abdominal pain: antispasmodics (hyoscyamine, peppermint oil)
second line: secretagogues (linaclotide, lubiprostone, plecanatide, tenapanor)
third-line: tegaserod
**add or switch to low dose TCA