19. Constipation

Question 1

What 4 main categories can you classify causes of constipation into ?

Answer 1

Abnormal peristalsis
Hard faeces
Bowel obstruction
Patient not pushing

Question 2

What can cause abnormal peristalsis?

Answer 2

IBS

Medications- opiates, iron, calcium channel blockers

Question 3

What can cause hard faeces?

Answer 3

Lack of fibre

Dehydration

Question 4

What can cause bowel obstruction?

Answer 4

Colorectal adenocarcinoma

Sigmoid volvulus

Question 5

What can cause the patient to avoid pushing when they go to the toilet?

Answer 5

Haemorrhoids, anal fissues, pelvic floor dysfunction

Question 6

What are the red flags fro cosntipation?

Answer 6

1. severe persistent constipation with no improvement on medication
2. Absolute constipation with no gas passing
3. Rectal bleeding, tenesmus, mucoid diarrhoea
4. FLAWS
5. PMHx UC/ Polyps
6. FHx polyps/ cancer

Question 7

What associated symtpoms should you ask about in someone with constipation?

Answer 7

Diarrhoea, tenesmus, blood, bloating, hypothyoidism symptoms, bone pains and polyuria

Question 8

What may polyuria suggest in someone with constipation?

Answer 8

Hypercalcemia

Question 9

What are risk factors for constipation?

Answer 9

History of bowel disease, endo/ neuro disease, back problems

FHx of bowel disorders

Poor diet

Question 10

In what neurological conditions may patients have constipation as well?

Answer 10

Diabetic neuropathy, multiple sclerosis, cord compression or parkinsonism

Question 11

What blood tests may be relevant in someone with constipation?

Answer 11

Full blood count- colonic mass can cause anaemia
Electrolytes anc alcium
TFTs

Question 12

What are markers for colon cancer?

Answer 12

CEA, Ca 19-9