Constipation

Question 1

What is constipation?

Answer 1

• Infrequent/Difficulty passing stools, usually defined as less than 3 times a week

Question 2

What is chronic constipation?

Answer 2

Symptoms which are present for atleats 3 months

Question 3

What other symptoms may present alongside constipation in elderly?

Answer 3

• Confusion/Delirium
• Nausea or loss of appetite
• Overflow diarrhoea
• Urinary retention

Question 4

What are risk factors for constipation?

Answer 4

Social: Low fibre diet/calories, difficulty getting to the toilet, lack of mobility
Psychological: Anxiety/Depression, Eating disorders
Physical: Females, older age, pyrexia

Question 5

What are secondary causes of constipation?

Answer 5

• Analgesics such as opiates
• Antimuscarinics/Antidepressants
• Antipsychotics
• Antiepileptics
• Endocrine: DM, electrolyte imbalances
• Neuro: MS, Parkinsons, Spinal injuries

Question 6

How is constipation investigated?

Answer 6

• Check for any red flags
• DRE to assess tone/anal sphincter

Question 7

How is constipation managed conservatively?

Answer 7

• Advice re balanced diet with gradual increase in fibre intake
• Ensure good fluid intake
• Helpful toileting advice

Question 8

How is constipation managed medically?

Answer 8

1st line: Bulk forming laxatives which retain fluid within the stool e.g. Isphagula husk
2nd line: Osmotic laxative which help increase fluid in large bowel e.g. Lactulose/Macrogols
3rd line: Stimulant laxatives which help with peristalsis e.g. Senna, Bisacodyl

Question 9

How to manage opioid-induced constipation?

Answer 9

• Use osmotic/stimulant laxatives
• Bulk forming laxatives should not be used

Question 10

How do you manage faecal loading/impaction?

Answer 10

1st line: Suppository such as bisacodyl or glycerol
2nd line: Mini enema such as docusate
3rd line: Sodium phosphate enema

Question 11

How should laxatives be stopped?

Answer 11

Weaned over weeks/months after regular bowel movements with soft stools have been established