Constipation

Question 1

What is included in the possible aetiology of obstructed defaecation syndrome?

Answer 1

Rectocoele

Rectal Intussusception

Anismus - damage to nerves supplying rectum (Pudendal)

Idiopathic megarectum - poor innervation

Question 2

What are dysmotile causes of constipation?

Answer 2

IBS, chronic constipation

Question 3

What are the primary investigations for constipation?

Answer 3

Barium enema/colonoscopy/CT colonogram

Question 4

What are secondary investigations for constipation?

Answer 4

Defaecating proctogram

Colonic transit study

EAUS

Anorectal Phsyiology

Question 5

What does colonic transit study involve?

Answer 5

Patient takes shapes, X-ray at day 5 - should be gone by 3.

Question 6

If shapes are found in colonic transit study in the following areas, what does it suggest the problem is?

Rectum

Scattered Throughout

Recto-sigmoid junction

Answer 6

Rectum - degree of anismus

Scattered throughout - hypomotility/colonic inertia

Recto-sigmoid - outlet obstruction

Question 7

What does anorectal physiology involve?

Answer 7

Mamometry

Balloon inlation - compliance

Pudendal nerve terminal motor latency

EMG (electromyography) recording