Constipation

Question 1

Define constipation

Answer 1

• Infrequent bowel movements
• Less than 3 per week
• Often with hard, dry stools that can be difficult or painful to pass

Question 2

4 main causes of constipation

Answer 2

• Physiological eg low fibre
• Iatrogenic eg opioids
• Pathological eg hypothyroidism
• Functional eg painful defecation with anal fissure

Question 3

Symptoms of constipation

Answer 3

• Lower abdominal pain
• If severe, can have abdominal distension, nausea/vomitting or decreased appetite

Question 4

Examination of constipation

Answer 4

• No clinical signs
• If severe, abdominal distension or tenderness secondary to faecal impaction
• NEED to do DRE

Question 5

Investigations for constipation

Answer 5

• None needed really -clinical diagnosis
• If severe/resistant or no cause can be identified could do bloods eg TFTs, Ca2+
• X-ray and CT not indicated in routine cases

Question 6

Conservative management constipation

Answer 6

• Adequate hydration
• Dietary fibre
• Treat underlying cause
• Mobilise

Question 7

Laxative classes to use in constipation

Answer 7

• Osmotic - increase fluid in bowel - eg lactulose/movicol
• Stimulant - stimulate contraction, expel stool eg senna/picosulfate
• Bulk forming - helps stool retain water eg isphagula husk
• Rectal medications eg suppositories like phosphate enema and glycerin

Question 8

Which laxative to use for constipation?

Answer 8

• Depends on what you find on PR exam
• If it is hard stool, need something to soften the stool eg Lactulose but may need suppository to soften initially
• If post op ileus, may benefit from stimulant laxative