65. Constipation

Question 1

What are the broad causes of constipation?

Answer 1

Lifestyle (poor diet, old age, shyness)

IBS

Anorectal disease (prolapse,carcinoma)

Intestinal obstruction

Metabolic functions (hypercalcaemia, hypothyroidism, hypokalaemia)

Drugs (opioids, anticholinergics,iron)

Neuromuscular (hirschprung’s,)

Question 2

What tests are done for constipation?

Answer 2

Bloods: FBC,U&E’S,Ca, TFT
Colonoscopy
PR exam before referral

Question 3

What is the treatment of constipation?

Answer 3

Reassurance and dietary changes: high fibre

Bulking agents: increase faecal mass (bran powder, fybrogel)

Stimulant laxatives: stimulate bowel (docusate) don’t use in obstruction

Stool softeners: particularly good in fissures (archaris oil enemas)

Osmotic laxatives: retain fluid in bowel (lactulose)

Question 4

How do you treat constipation if initial treatments don’t help?

Answer 4

Prucaloperide- prokinetic drug

Linaclotide

MDT approach with behaviour therapy, habit training and sphincter feedback

Question 5

If someone has constipation and mennorrhagia what would you think?

Answer 5

Hypothyroidism