(On Tuesday, January 24, 2023). Gastroenterology and/or Gastrointestinal Complaint of Constipation and (Irritable Bowel Syndrome [IBS] Association). In the Case Scenario of Constipation (Normal Homeostatic Range 3 Defecations Per Week to Three Perdiem). Otherwise, the Criteria of Constipation is Straight and without much Controversy. DDx: 1) Irritable Bowel Syndrome (IBS) Constipation Type (IBS-C); 2) Bowel Obstruction (Malignancy [Neoplasm] or Stricture; 3) Anatomical Abnormalities: a) Anal Stricture; b) Anal Fissure; c) Rectocele; d) Rectal Prolapse; e) Diverticulosis; 4) Pelvic Floor Dyssynergia (Postpartum Anatomic Lesion); 5) Systemic Aetiologies: 1) Hypothyroidism (TSH and Low Metabolic Homeostasis); 2) Hypercalcemia (Serum Calcium Level High); 3) Hypokalemia (High Potassium Levels in Serum); 4) Neurologic Disorders (Parkinson's Disease [Dyskinesia and Cognition Changes] Multiple Sclerosis [MS]); 5) Psychiatric Disorders: 1) Depression (Seasonal or Chronic); 2) Eating Disorders (Anorexia Nervosa, Bulimia and/or Metabolic Syndrome); 6) Medications (Medical Therapy and/or Illicit Drug Use [Heroine Use, Narcotics]); Some Common Examples: 1) Opioids (Drug Class); 2) Iron Supplementation (Common Female Prescription and Supplementation); 3) Antihistamines; 4) Diuretics; 5) Calcium Channel Blockers (CCBs); 6) Selective Serotonin Reuptake Inhibitors (Some SSRIs); 7) Anticholinergics (Atropine, Scopolamine, And The Like) Dx: Initial Workup Basic Laboratory Assessment: 1) Complete Blood Count (CBC); 2) Basic Metabolic Panel (BMP); 3) Calcium Serum Level; 4) Magnesium Serum Levels (Not included in BMP so Separate, Specific Order); 5) Thyroid Stimulating Hormone (TSH, A Pituitary Gland Hormone to Thyroid Targe and Hypothyroidism Exclusion); 6) Abdominal X-Ray (For Visualization of Morphology and Malignancy Basis [Exclusion of Worst Possible Cause]). A Fecaloma (Abnormal Compacted Mass of Feces); On Matters of IBS the Rome Criteria (IV) is Standard for Such Diagnosis which includes Recurrent Abdominal Pain Prior to the Diagnosis of at Least Six Months (Chronic Manifestation of Constipation) and two or more Positive Associations of the following: 1) Pain Alleviation Pattern Post Defecation; 2) Stool Frequency Changes (Decrease or Increases); 3) Change in Stool Morphology (Form, Shape or Appearance); Generally, Physical Examination, Laboratory Investigations will be Normal Suggesting No Organic Structural Deficits; Risk Factors (RFx) and Associations (Ax) of IBS: 1) Age Less Than 50 (Young, Non-Menopausal); 2) Female; 3) Sexual and/or Physical Abuse History (Hx); 4) Post-Traumatic Stress Disorder (Thereby a Psychiatric Element Always Associated); 5) And Family History (FHx) of IBS; Thereafter, the SSx Herein in Case Scenario: 1) Constipation for 9 Months Prior; 2) Frequency is Low and Diagnostic (2 or less Per week); 3) Appearance Of Stool (Morphological Changes in Stool); 4) Defecation Alleviates (Or Makes Pain Less) is Positive; and Treatment (Tx) or Management (Mx): 1) Lifestyle Changes Recommendation (Suggestion); a) Advise of Diet High In Fiber (Soluble Better than Non) with b) Weekly increases (Rather than Initial High); c) Appropriate Hydration and Increasing such; d) Activity and Exercise is to be High, or Higher; e) Mediation Alert of Possible Side Effects of Constipation; 2) Laxatives Via Psyllium (A Bulk Laxative) as First Line Laxative (With Secondary being only for Refractory Cases); Available with the Brand Name Metamucil; and Lastly 3) Follow up at Six Weeks (Monitoring Treatment and Progress); Second-Line Laxatives are 1) Osmotic Laxatives (Lactulose and Magnesium Based); 2) Stimulant Laxatives (Bisacodyl, Dulcolax or Senna); The Duration of Laxative Treatment is 6 Months (Duration of Treatment Minimum); Alarm Symptoms or Red Flags (Complications of IBS-C); 1) Gastrointestinal Bleeding (Hemorrhage or Positive Fecal Ocult Test [FOT]); 2) Anemia (Of Blood Loss); 3) Weight Loss; 4) Colonoscopy is Overdue (Lacking Visual Enterological Assessment), 5) Geriatric Subjects (Advanced Age) with Alarm Symptoms; 6) Refractory To Treatment Warrants Gastroenterological Referral (Specialist Consultation); Goodness, my First IBS-C Diagnosis And Treatment. Not Really, the Situation was Aggravated by Suicidal Ideation and Psychiatric Attention (Referral and High Potency Treatment was Mandatory, Haloperidol. MD Pual W. Bolin, es gut ist zu wiedersehen und Lehrer mit ihnen. Heil!

Checking in for the best medical cases out there !

Much appreciated, Dr Bolin. 🙏

awesome content! thanks doctor!

Our surgery patients ending up with paralytic ileus usually are getting an NG tube if vomiting and metoclopramide q6h to increase GI motility until a bowel movement occurs.

Thank u so much from Ethiopia 🇪🇹🇪🇹🇪🇹🇪🇹

Thank you sir ☺️

Thankfully

Is Pelvic floor dyssnergia the same as myofascial pelvic pain?

Thank you!