Constipation

Question 1

What criteria are used to classify constipation?

Answer 1

Rome IV

Question 2

What are risks factors for constipation?

Answer 2

Advanced age
Inactivity
Low calorie intake
Low fibre diet
Medications
Female sex

Question 3

What are the stages in the Bristol stool chart?

Answer 3

Type 1 - hard lumps, like nuts
Type 2 - sausage-shaped, but lumpy
Type 3 - sausage-shaped, with cracks on the surface
Type 4 - like a smooth sausage or snake
Type 5 - soft blobs with clear cut edges
Type 6 - fluffy pieces with ragged edges, mushy
Type 7 - watery, no solid pieces

Question 4

What are alarm symptoms that can be paired with constipation?

Answer 4

Weight loss
Loss of appetite
Abdominal mass
Dark stool

Question 5

What are causes of constipation? (9)

Answer 5

1. Dietary e.g. inadequate fibre intake, inadequate fluid intake
2. Behavioural e.g. inactivity, avoidance of defecation
3. Electrolyte disturbance e.g. hypercalcaemia
4. Drugs, particularly opiates, calcium channel blockers and some antipsychotics
5. Neurological disorders e.g. spinal cord lesions, 6. Parkinson’s disease, diabetic neuropathy
6. Endocrine disorders e.g. hypothyroidism
7. Colon disease e.g. stricture, malignancy
8. Anal disease e.g. anal fissure, proctitis

Question 6

How would you manage constipation?

Answer 6

Exclude underlying causes including colorectal cancer
Lifestyle modification e.g. dietary improvements, increase exercise
Enemas if impaction present e.g. sodium citrate
Suppositories e.g. glycerol