Constipation

Question 1

What are the risk factors for constipation?

Answer 1

Increasing age
Inactivity
Low fibre diet
Medications
Low calorie intake
Surgical procedures
Female

Question 2

What are the symptoms of constipation?

Answer 2

Passing stools < 3 times per week
Difficulty passing stools
Sensation of incomplete evacuation - tenesmus
Abdominal distension
Abdominal mass in left or right lower quadrants
Haemorrhoids

Question 3

What are the red flag features of constipation?

Answer 3

Weight loss
Dark stools
Abdominal mass
Loss of appetite

Question 4

What investigations would you perform for a constipated patient?

Answer 4

DRE
FBC
U&E
TFTs
Abdominal XR
Colonoscopy
Barium enema

Question 5

What are the causes of constipation?

Answer 5

Dietary - low calorie, low fibre
Behavioural - avoidance of defecation
Electrolyte disturbance
Drugs - opiates, calcium channel blockers, antipsychotics
Neurological disorders
Endocrine disorders
Colon disease - cancer, stricture
Anal disease - fissure

Question 6

What is the initial management of constipation?

Answer 6

Lifestyle advice
- Increase fibre
- Increase calorie intake
- Increase fluid intake
- Regular exercise

Question 7

What is the initial pharmacological management of constipation?

Answer 7

Bulk laxative
- ispaghula husk
- Methylcellulose

Question 8

What other medications can be used to manage constipation?

Answer 8

Stool softeners - docusate sodium
Osmotic laxatives - lactulose, macrogol
Stimulant laxatives - senna

Question 9

What other management options are there for constipation?

Answer 9

Enema if stool is impacted
Suppositories

Question 10

What type of stools does constipation usually present with?

Answer 10

Type 1 or 2
Can be type 7 if there is overflow diarrhoea