Constipation Flashcards
How may constipation present?
Typical features in the history and examination that suggest constipation are:
- Less than 3 stools a week
- Hard stools that are difficult to pass
- Rabbit dropping stools
- Straining and painful passages of stools
- Abdominal pain
- Holding an abnormal posture, referred to as retentive posturing
- Rectal bleeding associated with hard stools
- Faecal impaction causing overflow soiling, with incontinence of particularly loose smelly stools
- Hard stools may be palpable in abdomen
- Loss of the sensation of the need to open the bowels
What is encopresis?
Encopresis is the term for faecal incontinence. This is not considered pathological until 4 years of age. It is usually a sign of chronic constipation where the rectum becomes stretched and looses sensation. Large hard stools remain in the rectum and only loose stools are able to bypass the blockage and leak out, causing soiling.
What causes encopresis?
Other rarer causes of encopresis include:
- Spina bifida
- Hirschprung’s disease
- Cerebral palsy
- Learning disability
- Psychosocial stress
- Abuse
What liftstyle factors contribute to the development and continuation of constipation?
There are a number of lifestyle factors that can contribute to the development and continuation of constipation:
- Habitually not opening the bowels
- Low fibre diet
- Poor fluid intake and dehydration
- Sedentary lifestyle
- Psychosocial problems such as a difficult home or school environment (always keep safeguarding in mind)
Briefly describe the problem of desensitisation of the rectum
Often patients develop a habit of not opening their bowels when they need to and ignoring the sensation of a full rectum. Over time they loose the sensation of needing to open their bowels, and they open their bowels even less frequently. They start to retain faeces in their rectum. This leads to faecal impaction, which is where a large, hard stool blocks the rectum. Over time the rectum stretches as it fills with more and more faeces. This leads to further desensitisation of the rectum. The longer this goes on, the more difficult it is to treat the constipation and reverse the problem.
Give examples of secondary causes of constipation
- Hirschsprung’s disease
- Cystic fibrosis (particularly meconium ileus)
- Hypothyroidism
- Spinal cord lesions
- Sexual abuse
- Intestinal obstruction
- Anal stenosis
- Cows milk intolerance
What are the red flags of constipation?
- Not passing meconium within 48 hours of birth
- Neurological signs or symptoms, particularly in the lower limbs
- Vomiting
- Ribbon stool
- Abnormal anus
- Abnormal lower back or buttocks
- Failure to thrive
- Acute severe abdominal pain and bloating
What may not passing meconium within 48 hours of birth indicate?
Cystic fibrosis or Hirschsprung’s disease.
What may neurological signs or symptoms, particularly in the lower limbs indicate?
Cerebral palsy or spinal cord lesion.
What may vomiting indicate?
Intestinal obstruction or Hirschsprung’s disease.
What may ribbon stool indicate?
Anal stenosis.
What may abnormal anus indicate?
Anal stenosis, inflammatory bowel disease or sexual abuse.
What may abnormal lower back or buttocks indicate?
Spina bifida, spinal cord lesion or sacral agenesis.
What may failure to thrive indicate?
Coeliac disease, hypothyroidism or safeguarding.
What may acute severe abdominal pain and bloating?
Obstruction or intussusception.
