Constipation

Question 1

How are bowel movements adequately carried out?

Answer 1

Proximal colon is the key to stool formation

Neuronal input for stimulus

Requires adequate fluid intake , as well as intact sphincters/enough squeezing pressure

Question 2

What are the causes of constipation?

Answer 2

Low fibre

Poor mobility

Drugs: opioids, anticholinergics

Dehydration

Hypercalcaemia

Parkinson’s

Question 3

What is overflow diarrhoea?

Answer 3

Constipated stool in the bowel is so hard that it can’t be pushed out. The bowel begins to leak out watery stool around the impacted faeces. The leakage can soil underwear and appear as diarrhoea.

Question 4

What clinical problems can occur due to constipation?

Answer 4

Abdominal pain

Vomiting/nausea

Rectal discomfort

Overflow diarrhoea/incontinence

Rectal bleeding from haemorrhoids

Delirium

Depression

Question 5

How is assessment of constipation carried out?

Answer 5

• Frequency of passing stool and what is their normal - should move bowels at least every 3 days.
• Consistency using (bristol stool chart)
• Any difficulties evacuating/feeling of incomplete emptying.
• Also ask about fluid intake, diet and exercise.

Question 6

How is examination for constipation carried out?

Answer 6

Abdominal examination

Rectal examination - hard stool/empty rectum, tone/sensation, local pathology (e.g. fissure/haemorrhoids, mass lesion, bleeding), evidence of incontinence.

Question 7

Management of hard stool issue in constipation?

Answer 7

Osmotic laxatives
- Laxido with 125ml water (up to 6 satchets per day in total and adjust with BSS).

• Lactulose (15-20ml per day and can be increased depending on BSS)