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Clinical Pathways promote evidence based, safe, and high-value care for patients by providing clinical recommendations and standard processes. They are developed by multidisciplinary committees of subject matter experts, informed by methodical review of available evidence and consensus among committee members.  

Clinical Pathway: 

Inclusion and exclusion criteria


  • > 2 years of age.
  • Two or fewer defecations per week .
  • History of:  
    • Excessive stool retention.
    • Painful or hard bowel movements. 
    • Large diameter stools.
  • Presence of large fecal mass in the rectum. 


  • Signs/symptoms of bowel obstruction. 

Team members involved in the development: 

  • A. Daly, MD | Hospital Medicine | Committee chair 
  • K. Kaufman APRN | Gastroenterology | Committee member 
  • B. Weller PharmD | Pharmacy | Committee member 
  • N. Sharma MHA | Quality Improvement Consultant | Committee member 
  • L. Schroeder MD | Chief Medical Quality and Safety Officer | Committee member 
  • H. Nall DNP, APRN, FNP-C, CPEN | Neurology | Committee member 
  • J. Johnson MD, FAAP | Director, Division of Urgent Care | Committee member 
  • H. Johnson MD | Emergency Medicine | Committee member 
  • S. Dillman MD | Emergency Medicine | Committee member 
  • C. Kapalu PhD | Gastroenterology | Committee member 
  • D. Wyly MSN, RN, APRN, CPNP-AC, PPCNP-BC, ONC | Urgent Care Clinics | Committee member 
  • J. Bartlett PhD, RN | Evidence Based Practice Department | Committee member 
  • N. Allen MS, MLS, RD, LD, CPHQ | Evidence Based Practice Department | Committee member 

Publication dates: 

  • Finalized date: February 2021 
  • Next expected revision date: February 2024

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These pathways do not establish a standard of care to be followed in every case. It is recognized that each case is different, and those individuals involved in providing health care are expected to use their judgment in determining what is in the best interests of the patient based on the circumstances existing at the time. It is impossible to anticipate all possible situations that may exist and to prepare a pathway for each. Accordingly, these pathways should guide care with the understanding that departures from them may be required at times.