Constipation

Question 1

Constipation

Answer 1

infrequent bowel movements (<3 a week)

• hard
• dry
• painful and difficult to pass

Question 2

Aetiology

Answer 2

Physiological – low fibre diet, poor fluid intake, or low physical activity

Iatrogenic – opioid analgesia, anticonvulsants, iron supplements, or antihistamines

Pathological – bowel obstruction, hypercalcaemia, hypothyroidism, or neuromuscular disease

Functional – from painful defecation (such as anal fissures)

Post op ileus

Question 3

Clinical Features

Answer 3

Lower abdominal pain

• abdo distention
• N+V
• decreased appetite

Question 4

Ix

Answer 4

Clinical normally

DRE

Bloods - TFTs, Ca2+

AXR - if obstruction suspected

Question 5

Mx

Answer 5

Conservative:

• increase fibre intake
• early mobilisation
• optimise hydration

Pharmacological:
- Laxatives

Question 6

Osmotic laxatives

Answer 6

Hard stool or chronic constipation

increase the amount of fluid in the bowel thereby softening stool. e.g. lactulose, movicol

Question 7

Stimulant laxatives

Answer 7

Paralytic ileus

stimulate the bowel to contract thus expelling faeces. e.g. senna

Question 8

Bulk forming laxatives

Answer 8

help stool to retain water thereby softening stool. e.g. ispaghula husk

Question 9

Rectal medications

Answer 9

glycerin suppository (stimulant), phosphate enema (stimulant)

Question 10

Prophylaxis

Answer 10

Opioid analgesia should be avoided

Prophylactic stimulant laxatives

Question 11

When to give senna

Answer 11

When unable to pass stool as stimulant