Constipation

Question 1

What is Constipation?

Answer 1

• Infrequent bowel movements
• Difficulty passing stools

Question 2

Aetiology

Answer 2

• Lack of physical activity, poor fluid intake
• Poor fibre intake, high processed foods
• Meds: opioids, some antidepressants
• Hypothyroidism, IBS

Question 3

Pathophysiology

Answer 3

• Eat = food broken down In stomach and small intestine, nutrient absorbed
• Waste = goes to large intestine/colon = water absorbed = stool formed
• Peristalsis = move stools towards rectum
• Constipation = the process above disturbed = slow transmit time and drier stool consistency

Question 4

Risk Factors

Answer 4

-Age, female (pregnancy)
-Some meds, Parkinson’s disease, MS, diabetes

Question 5

Signs/Symptoms

Answer 5

• Bowel movements less than 3 times per week
• Straining/incomplete poo
• Abdominal pain, bloating/ abdomen feels heavy

Question 6

Diagnosis

Answer 6

• History and examination
• Bloods
  o FBC,TSH: rule out hypothyroidism
  o U&E: rule out hypercalcemia and dehydration
  o CRP/ESR
  o Abdominal X ray/abdominal ultrasound
  o Colonoscopy

Question 7

Management

Answer 7

• Increase fibre in diet
• Laxatives:
  o Bulk forming : has fibre, promote bowel movements = absorb water in intestines, soften stool, increase stool bulk
  o Stool softener (emollient laxatives) = moisten and lubricate stool – easy to poo = sodium docusate
  o Osmotic laxatives = draw water into intestines = soften stool, promote bowel movement = lactulose
  o Stimulant laxatives = increase bowel movements stimulate muscle of intestine, tend to be prescribed for short term relief Senna.