Constipation

Question 1

What is constipation?

Answer 1

Infrequent bowel movements <3/week or opening bowels less frequently than normal with increased difficulty, straining or pain

Question 2

Causes of constipation

Answer 2

OPENED IT

Obstruction
Pain - anal fissure, haemorrhoids, proctalgia fugax
Endocrine/ electrolytes - hypothyroid, hypocalcaemia, hypokalaemia, uraemia
Neuro - MS, myelopathy, cauda equina syndrome
Elderly
Diet/ dehydration
IBS
Toxins - opioids, Anti-mACh

Question 3

What are the types of obstruction that can cause constipation?

Answer 3

Mechanical: adhesions, hernia, ca, inflammatory strictures, pelvic mass
Pseudo-obstruction: post-op ileus

Question 4

Management of constipation - conservative

Answer 4

Drink more

Increase dietary fibre

Question 5

Medical management of constipation: bulking agents

Answer 5

Bulking --> increases faecal mass --> increases peristalsis 
CI: obstruction and faecal impaction
Bran 
Ispaghula husk (fybogel)
Methylcellulose

Question 6

Medical management of constipation: osmotic agents

Answer 6

Osmotics - increase water retention in the bowel
Lactulose
MgSO4 - rapid

Question 7

Medical management of constipation: stimulant agents

Answer 7

Increase intestinal motility and secretion
CI: obstruction, acute colitis 
SE: abdo cramps 
Bisacodyl PO or PR 
Senna 
Docusate sodium
Sodium picosulphate (rapid)

Question 8

Other forms of medical management for constipation

Answer 8

Softeners - useful to manage painful anal conditions - liquid paraffin
Enemas - e.g. phosphate enema - osmotic
Suppositories e.g. glycerol (stimulant)