Constipation Flashcards
What is constipation?
stool that is passed infrequently and/or with difficulty
What do you have to clarify with constipation and patients?
what patient means by constipation: write in notes about frequency, ease of passage and volume
What 4 things are needed for normal defecation?
- Adequate bowel peristalsis
- Relatively soft feaces
- No obstruction to outflow
- Will and ability to push
What are the abnormal bowel peristalsis reasons for constipation?
- IBS
- Medications (e.g. opiates, iron supplements, CCBs)
- Hypothyroidism
- Hypercalcaemia
- Hypokalaemia
- MS
- Parkinson’s
- Diabetic neuropathy
- Idiopathic megascolon
- Idiopathic slow trasnit
What are the hard feaces reasons for constipation?
- Lack of dietary fibre
2. Dehydration
What are the bowel obstruction reasons for constipation?
- Colorectal adenocarcinoma
- Sigmoid Volvus
- Other pelvic masses (e.g. uterine fibroids, ovarian tumour)
- colonic strictures (e.g. radiotherapy, Crohn’s disease, diverticular disease)
What are the patient not pushing reasons for constipation?
- Haemorrhoids
- Anal fissue
- Pelvic floor dysfunction (e.g. after hysterectomy)
What non medical reasons are there for constipation?
- due to uncomfort of hospital
- if immobile (e.g. spinal pathology, old age) prone to constipation
What are the 6 red flags of constipation?
- Severe persistent constipation that is unresponsive to treatment
- Absolute constipation, i.e. not passing either stool or flatus
- Rectal bleeding, tenesmus, or intermittent mucoid diarrhoea
- Significant weight loss, iron deficiency anaemia, and/or night sweats
- PMHx of UC or colonic polyps
- Strong FHx of colon cancer or colonic polyps, particularly if affected family members were <60y
What questions do you ask about the constipation?
- characterise what patient means by constipation
2. when did it start
What would being constipated with passing hard, lumpy stool suggest?
lack of fibre or dehydration but no obstruction
What would constipation with no feaces or flatus suggest?
obstruction
What does recent change in bowel habit suggest?
pathology
What would chronic constipation suggest?
usually benign cause
What are associated symptoms of constipation should you ask about?
- Weight loss, night sweats, fever
- Diarrhoea
- Tenesmus
- Blood on feaces, per rectum or when wiping
- Bloating
- Feeling cold, reduced appetite, gaining weight
- Bone pain?
- Polyuria, thirst
- Note any abdominal pain
What could weight loss, night sweats, fever with constipation suggest?
malignancy
What could intermittent constipation and diarrhoea suggest?
- IBS (younger patients)
- Colorectal cancer (>45 years and diarrhoea mucoid)
- Diverticular disease (>60 years + episodes of LIF pain)
What would tenesmus and constipation suggest?
persistent mass in rectum
What could blood on feaces, per rectum or when wiping with constipation suggest?
- heamorrhoids
- anal fissure
- diverticular disease
- colorectal cancer
What could bloating and constipation suggest?
IBS
What could feeling cold, reduced appetite, gaining weight and constipation suggest?
hypothyroidism
What could bone pain and constipation suggest?
bone metastases which lead to hypercalcaemia that can cause constipation
What could polyuria, thirst and constipation suggest?
hypercalcaemia
What are the risk factors for constipation?
- Hx of bowel disease, neurological disorders, back problems or endocrine disease
- FHx of bowel disease
- MHx
- Diet
What FHx of bowel disease is relevant for constipation?
esp if increase chance of colorectal cancer, FAP, HNPCC or Peutz-Jegher’s disease
What medications can cause constipation?
- opiates
- anticholinergics
- tricyclic antidepressants
- CCB
- iron supplements