Constipation Flashcards
What is constipation defined as?
Reduced frequency of defecation to twice weekly or less.
What are the three clinical subtypes of constipation?
- Normal transit with hard stools or difficulty in evacuation
- Slow colonic transit with reduced frequency or absence of urge to defecate
- Incoordination of rectum, anus, and pelvic floor
What psychological factors can contribute to constipation?
- Anorexia
- Dementia
- Sexual abuse
- Grief
What are some common drugs that can cause constipation?
- Analgesics like opiates
- Anticholinergics including antipsychotics
- Anti-parkinsonian drugs
- Antispasmodics
- calcium channel blockers
What congenital conditions should be evaluated in a patient with constipation?
- Hirschsprung’s disease
- Meningocele
What dietary factors contribute to constipation?
- Low fiber diet
- Lack of fluid intake
- Caffeine abuse
- Overuse of alcohol
What lifestyle factors can lead to constipation?
- Sedentary lifestyle
- Prolonged immobility, especially in the elderly
What endocrine disorders can cause constipation?
- Hypothyroidism
- Hypercalcemia
- Hypokalemia
- Phaeochromocytoma
- Glucagonoma
What neurological diseases are associated with constipation?
- Neuropathy
- Multiple sclerosis
- Parkinson’s disease
- Cord compression
- Stroke
How is the pelvic floor’s function related to constipation?
Animus can cause constipation, which is the failure of the pelvic floor muscles to relax during defecation.
What are the complications of constipation?
- Urinary retention
- Faecal incontinence
- Rectal prolapse
- Anal fistula
- Stercoral perforation
- Volvulus
What is faecalith?
A stone made of faeces, typically found in the descending and sigmoid colon.
What diagnostic approaches are used for constipation?
- Colonoscopy
- Flexible sigmoidoscopy
- FBC for faecal occult blood
- Upright chest radiography
- Rectal biopsy
- Anorectal manometry
What is the first-line treatment for managing constipation?
Increasing dietary soluble fiber and adequate fluid intake.
What are sources of dietary fiber?
- Cereals
- Breads
- Fruits
- Vegetables
- Peanuts
What is the diagnostic approach for constipation?
Colonoscopy
Flexible sigmoidoscopy
FBC for faecal occult blood and WCC count, and metabolic profile including thyroid
Upright chest Radiolohraphy to assess for megacolon and Colonic dilatation
Rectal biopsy and radiology for Hirschsprung’s disease
Anorectal manometry to evaluate function of rectal and anal muscles by inserting a catheter with pressure sensors into the anu
Which laxatives are given for constipation?
bisacodyl and docusate
What is the first line treatment for constipation?
isphagala husk with increasing fluid intake
What is the role of Docusate in treating constipation?
Stool softener that increases the water and lipid content of stools.
What is the second-line treatment for constipation?
Osmotic laxative like macrogol.
What is prucalopride used for?
A last-line treatment for chronic constipation that stimulates gastric motility.
What is the difference between a suppository and an enema?
A suppository is a small solid capsule; an enema is liquid medication.
What is the ideal laxative for proximal faecal impaction?
Polyethylene glycol, an osmotic laxative.
What is the first-line oral laxative for faecal loading/impaction?
Macrogol.
