A 26-year-old woman with a history of spina bifida complains of worsening constipation; she ran out of her supplies and medications over a week ago, and since then has not had a bowel movement.  The woman has no fever, chills, abdominal pain, or hematochezia; she has been passing flatus normally.  She is concerned that her worsening constipation will keep her from her college classes.

Her surgical history is significant for neonatal closure of her myelomeningocele, ventriculoperitoneal shunt placement, and Malone ACE procedure.

On exam, you see a well appearing young woman on a gurney in no apparent distress with normal vital signs.  Her general exam is normal and her abdominal exam shows two well healed stomata: one in her umbilicus and the other to the right of her umbilicus.  She has decreased bowel sounds and a soft, non-tender abdomen.

Which of the following is the BEST course of action at this time:

    A.    Irrigate the bowel
    B.    Double her dose of polyethylene glycol
    C.    Discharge home after ensuring close follow up
    D.    Prescribe a mild stimulant laxative such as senna glycoside

In the meantime, a quote –

“Why is patience so important?"
"Because it makes us pay attention.”

-- Paulo Coelho


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