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Worksheet

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
    movement
    Feeling 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.


    __________________________________________________________________
    __________________________________________________________________
    __________________________________________________________________
    __________________________________________________________________

     

Last modified on August 23, 2013 at 10:33:00 AM