Constipation that fiber and PEG did not fix, online

Common symptoms

• Hard or lumpy stools
• Straining to pass stool
• Fewer than 3 bowel movements a week
• Not feeling empty after a bowel movement

May fit online care

• Adults 18 and older
• You are 18 or older
• You have had constipation for 6 months or more
• In the last 3 months you had at least two of these: fewer than 3 bowel movements a week, or, on more than 1 in 4 bowel movements, straining, hard or lumpy stools, or not feeling empty afterward
• You tried more fiber and fluids for 2 weeks or more
• You tried PEG (such as MiraLAX) once a day for 4 weeks or more, and you are still constipated
• You have none of the warning signs below

Look for another care setting

• Severe belly pain (call 911 or go to the ER now).
• A belly that is swollen, hard, or rigid (call 911 or go to the ER now).
• Green or bloody vomiting, vomiting that will not stop, or vomiting blood (call 911 or go to the ER now).
• No stool and no gas passing at all (call 911 or go to the ER now).
• A lot of blood from your rectum (bottom), or black, tarry stool (call 911 or go to the ER now).
• New weakness in a leg, or new loss of control of your bladder or bowels (call 911 or go to the ER now).
• Fainting, confusion, or feeling very ill (call 911 or go to the ER now).
• More than a small streak of blood in your stool (go to the ER or urgent care today).
• A fever of 100.4 F (38 C) or higher, vomiting that keeps coming back, belly pain that does not go away, or new pain in your lower back (go to the ER or urgent care today).
• No stool for a week or more, or a hard blockage that will not pass (go to the ER or urgent care today).
• Weight loss you cannot explain, or very thin, ribbon-like stools (go to the ER or urgent care today).
• A weak immune system (go to the ER or urgent care today).
• A small amount of blood on the toilet paper or on your stool (see a doctor in person within 7 days).
• Iron-deficiency anemia (low iron in your blood) that a clinician already told you about (see a doctor in person within 7 days).
• Constipation that began in the last 12 months, and you are 45 or older (see a doctor in person within 7 days).
• A stool test, CT colon scan, or flexible sigmoidoscopy for colon cancer that came back positive or abnormal, with no colonoscopy after it (see a doctor in person within 7 days).
• A clinician told you that you have irritable bowel syndrome, or IBS (use our IBS follow-up visit).
• A parent, brother, sister, or child had colon or rectal cancer, Crohn's disease, ulcerative colitis, or celiac disease (see your own doctor).
• You are 45 or older and not up to date on colon cancer screening, or you do not know (see your own doctor).
• A doctor told you about a blocked or narrowed bowel, or you had bowel surgery in the last 30 days (see your own doctor).
• Belly pain at least once a week that is linked to going to the toilet (see your own doctor).
• Constipation that began after a new medicine, a supplement, or a new dose (see your own doctor).
• Opioid pain medicine on most days (see your own doctor).
• A condition that can cause constipation, such as an underactive thyroid, celiac disease, diabetes, Parkinson's disease, multiple sclerosis, or a spinal cord problem (see your own doctor).
• Loose or watery stools often, when you have not taken a laxative (see your own doctor).
• You are pregnant or might be pregnant (see your pregnancy doctor).
• You are under 18 (see your pediatrician or family doctor).
• Constipation for less than 6 months, or fewer than two of the usual problems in the last 3 months (use our constipation visit).
• More fiber and fluids tried for less than 2 weeks (use our constipation visit).
• PEG not tried, tried for less than 4 weeks, or your constipation is now gone or much better (use our constipation visit).
• If more than one fits, follow the first one.