CONSTIPATION Flashcards
What is constipation
Infrequent bowel movements or difficulty passing stool
Emphasis should be placed on …… in constipation diagnosis
Bowel habit of patient
Emphasis should be placed on …… in constipation diagnosis
Bowel habit of patient
Diarrhea alternating with constipation is likely to be due to …….in adults especially over 40 and ……. in children and the elderly
Large bowel malignancy
Chronic constipation with spurious diarrhea
Habitual use of Laxatives can cause Hypokalemia T/F
True
Medical causes of constipation
Diet deficient in roughage
Ignoring the urge to defaecate e.g. due to immobility
Hypothyroidism
Irritable bowel syndrome
Hypercalcaemia
Drugs
Lazy bowel
Lack of exercise
Dehydration and starvation
Drugs that can cause constipation
atropine
codeine
morphine
tricyclic antidepressants
disopyramide
Cause of lazy bowel syndrome
from chronic laxative use including ‘herbal’ preparations
Surgical causes of constipation
Gastrointestinal obstruction
Anal fissure and other painful perianal lesions
Carcinoma of the rectum and sigmoid colon
Foreign body in the gut
Pelvic mass e.g. fibroid, foetus
Aganglionic and acquired megacolon
Pseudo-bowel obstruction (Ogilvie syndrome)
Absent bowel sounds points to a suspicion of
Paralytic ileus
Symptoms of constipation
Inability to move bowels
Passing hard stools
Infrequent passing of stools
Straining to pass stools
Feeling of incomplete evacuation of bowel
Inability to pass flatus
Colicky abdominal pain with or without
vomiting
Signs of constipation
Frequent high pitched bowel sounds
Absent bowel sounds
Signs of peritonitis
Frequent high pitched bowel sounds gives a suspicion of
Mechanical bowel obstruction
Signs of peritonitis
Generalised tenderness
Guarding
Rebound tenderness
Investigations in constipation
Digital rectal examination
Stool for occult blood
Plain abdominal X-ray (erect and supine)
Proctoscopy/proctosigmoidoscopy/colonoscopy (must not be done
if acute intestinal obstruction is suspected)
This investigation must be carried out in all patients with
suspected diagnosis of constipation
Digital rectal examination
These investigations must not be done in constipation if acute intestinal obstruction is suspected
Proctoscopy/proctosigmoidoscopy/colonoscopy
Treatment objectives in constipation
To identify possible cause of constipation
To relieve constipation
Non-pharmacological interventions in constipation
Adherence to regular exercise
High fibre diet
Adequate fluid intake
Minimum fluid intake in constipation
Minimum of 3.2L of water per day if no contraindications exist
First line Management of constipation in adults
Bisacodyl PO
Or
Senna PO
Or
Lactulose PO
Bisacodyl dose in adults
PO 10-20 mg at night
Dose of glycerol suppositories in adults
Glycerol suppositories, rectal, 4 g at night
Dose for senna in adults
Senna, oral,
15-30 mg at bedtime
(maximum 70-100 mg daily)
Doses above 70 mg should be divided 12 hourly
Second line treatment of constipation in adults
Bisacodyl, rectal
Or
Glycerol suppositories,
Or
Liquid paraffin, oral,
Or
Milk of Magnesia, oral
Lactulose dose for constipation in adults
Lactulose, oral,
15-30 ml daily until response
then 10-20 ml daily
Dose of rectal bisacodyl in adults
Bisacodyl, rectal, 10 mg in the morning
Dose of liquid paraffin in adults
Liquid paraffin, oral, 10-30 ml at night
Dose of milk of magnesia for constipation in adults
Milk of Magnesia, oral, 5-10 ml in a glass of water, 12-24 hourly
Dose of rectal bisacodyl in children
Bisacodyl, rectal,
> 10 years; 5 mg in the morning
< 10 years; on medical advice only
Dose of lactulose for constipation in children
Lactulose, oral,
10-18 years; 15 ml 12 hourly
5-10 years; 10 ml 12 hourly
1-5 years; 5 ml 12 hourly
< 1 year; 2.5 ml 12 hourly
Dose of glycerol suppositories in children
Glycerol suppositories, rectal,
2-5 years; 2 g at night
< 1 year; 1 g at night
First line treatment of constipation in children
Lactulose oral
or
Glycerol suppositories
or
Bisacodyl rectal
or
Senna oral
Dose of oral senna for constipation in children
Senna, oral,
6-12 years; 5-40 ml at bedtime
2-6 years; 2.5-20 ml at bedtime
Magnesium salts should not be used in children with renal impairment. T/F
True
The following categories of patients with constipation should be referred to a surgeon
Patients with absent bowel sounds, vomiting or not passing flatus
Cases resistant to medical treatment
Any suspected surgical cause
