Constipation Case: What Would You Do?


I am looking for some feedback here.  How would you manage this case?

A patient in her early 30s states that she has taken a Dulcolax tablet daily for over ten years.  She states she spent most of that time in correctional facilities but never had any problem receiving an order for daily Dulcolax.  She was out of jail for a time and continued to take OTC Dulcolax.  She reports no abdominal work ups.  Her only surgery was an appendectomy.  Her only other medical problem is episodic asthma.  Her physical exam is normal.

She now has arrived at one of my jails and wants me to continue her daily Dulcolax prescription.  Should I?  Here is my thought process: Continue reading

Constipation: Straight Talk on the Last Taboo Subject

I have decided after many years of dealing with complaints of constipation both in the ER and in correctional facilities that bowel health is the last taboo subject.  We all received “The Talk” (about sex and reproductive health) when we were adolescents.  But nobody seems to talk about how to have a proper bowel movement.  It is a subject that inevitably causes giggling and uncomfortable laughter.  It is not spoken of in polite society.  As a result many people do not understand how their bowels work.  I have found this to be a big problem in the jails I work in.  Inmates complain of constipation when they are not really constipated.  They are bowel-fixated when there is no reason for them to be.  Often, they need education more than they need laxatives. To this end, I want to discuss several essential factors relating to understanding and treating constipation that may help make your correctional medicine practice a little easier. Continue reading