Constipation Flashcards
What is needed in initial evaluation of constipation?
Detailed history
PE
DRE
What might diagnostic evaluation of constipation include?
Colonoscopy
Colonic transit study
Anorectal manometry
Balloon expulsion study
What does initial treatment of constipation consist of ?
Lifestyle modifications
Laxatives
Define constipation
Polysymptomatic heterogenous disorder
Unsatisfactory defecation characterised by infrequent stools, difficult stool passage, or defecation that is both infrequent and/or difficult
What are the symptoms of constipation?
Excessive straining Sense of incomplete evacuation Failed or lengthy attempts to defecate Hard stools Less frequently
What are the risk factors for constipation?
Age > 65 years
Reduced fibre intake
Sedentary lifestyle
Use of meds that induce constipation
How do we define infrequent stools?
Rome IV criteria
<3 defecations per week
How can stool consistency be rated?
Bristol stool form scale
What are some uncommon diagnostic factors in constipation?
Abdo mass
Signs suggestive of underlying medical disorder
Anorectal lesions
Abnormality of DRE’s
What are some weak risk factors for constipation?
African ancestry Lower socioeconomic status FH Sedentary lifestyle Low fibre intake Inadequate calorie intake Inadequate fluid intake Surgical procedures and childbirth Medicines that induce constipation
What are 1st line investigations to order in constipation?
FBC TFTs Serum electrolytes, calcium, magnesium Blood glucose Abdo X-ray Barium enema
How do we define acute vs. ongoing constipation?
acute = less than 3 months ongoing = more that 3 months
What is the treatment for acute constipation?
Diet Lifestyle advice Laxatives Prunes Stool softners
+opioid induced evacuation measures
adj. methylnatrexone
What is the treatment for ongoing constipation?
Above plus:
osmotic laxatives
stimulant laxatives
