Talking to Your Doctor About Constipation
Print out and complete the questions below
When you visit your doctor you will want to know what is wrong, what the physician can do to treat it, and what you can do to better manage it. Your physician will begin by taking a history asking for a description of the symptoms as well as possible factors that can bring them on or
make them better. He or she will do a physical examination, possibly diagnostic tests, make a diagnosis, and discuss treatment options.
Management of a chronic condition such as constipation often is difficult and requires individual participation with a physician or other healthcare provider. Working together will help to develop a management or treatment plan designed to meet personal needs.
The course of chronic constipation varies from person to person. Here are some things you can do to help make your physician visit most effective.
- Inform your doctor of when you first were bothered by constipation,
how long it has been present and, if not always present, how many times it has recurred.___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________
- List the frequency of your bowel movements over the past 1-2 months.
Keep a daily diary to help sort this out (attach additional pages/list).Date & time
of bowel
movementStool form
Use the
guideline hereFeeling of
incomplete evacuation? (Yes, No)Straining
with stool (None,
Some, Too much)_______________ ______________ _____________ _________________ _______________ ______________ _____________ _________________ _______________ ______________ _____________ _________________
- Provide your doctor with a list of any other chronic illnesses you experience.
___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________
- List all prescription and nonprescription (over-the-counter) medications
including herbal supplements you currently take. Include dosage and frequency.Medication Dosage Frequency ___________________ __________________ ________________________ ___________________ __________________ ________________________ ___________________ __________________ ________________________ - Inform your doctor of any previous gastrointestinal procedures or tests.
Examples would include colonoscopy, sigmoidoscopy, endoscopy, and
ERCP (endoscopic retrograde cholangiopancreatography).Year Procedure/Test Results ______ ______________________ __________________________________ ______ ______________________ __________________________________ ______ ______________________ __________________________________ - Inform your doctor of any previous surgeries, especially abdominal or
gastrointestinal surgeries.Year Surgery ______ ___________________________________________________________ ______ __________________________________________________________ - Use the space below to write down any other questions you may have for
your doctor or to take notes during the appointment. It is imperative that
you walk away from your doctor’s appointment with a clear understanding
of what he or she tells you. Therefore, do not hesitate to ask questions.__________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________
