Blog | Thursday, April 10, 2014

Internal Medicine 2014: A healthy start to the day

Your grandmother was right, said Anthony J. Lembo, MD, during his session on chronic constipation. Prunes, or as they now prefer to be called, dried plums, really do work. Other low-cost treatments for constipation include putting a footstool in the bathroom (to achieve more of a squatting stance) and being physically active. "Professional athletes rarely have constipation issues," said Dr. Lembo.

Eating fiber is also good, of course, but breakfast in general can be helpful. For some patients, the cause of constipation is just being in too much of a hurry, said Dr. Lembo. They should take the time sit down for breakfast (one that includes some fat, which stimulates a colonic response) and if they drink caffeine, have that with breakfast. And then they should take the time to, ahem, sit down again.

If none of those strategies fix the problem, then it's reasonable to move on to other therapies, including commercial fibers and laxatives, advised Dr. Lembo. He also encouraged internists to try, from the start, to determine what subtype of constipation a patient has: slow transit (unusual), evacuation disorder (more common), or normal transit (the most common). "Identifying the subtypes can be important because it can alter your therapy," he said.

Oh, and, for a final cost-conscious tip, don't order a colonoscopy for a patient with chronic constipation but no alarm symptoms. He conducted an analysis of primary care medical records and "what was striking to me was the number of patients who had no obvious indication for a colonoscopy that ended up getting a colonoscopy," he said. "It is important that you actually indicate the rationale for what you did."