constipation

Question 1

What is the ROME criteria?

Answer 1

ROME criteria is a set of definitions for defining constipation:

a patient must have experienced at least 2 of the following symptoms over the preceding 3 months:

• Fewer than 3 bowel movements per week
• Straining
• Lumpy or hard stools
• Sensation of anorectal obstruction
• Sensation of incomplete defecation
• Manual maneuvering required to defecate

Question 2

What is constipation?

Answer 2

• A consistent difficulty in defecation

* ↑ transit time or pelvic dysfunction (rectoceole)

Question 3

What is the treatment from Constipation?

Answer 3

• Often it is simply reassurance, telling them to drink more and giving diet/exercise advice.
• High fiber diet → can cause bloating

Question 4

What are the medical treatments for constipation?

Answer 4

• Bulking agents - ↑ faecal mass stimulating peristalsis.
• Stimulant laxatives - Increase intestinal motility
• Osmotic laxatives - retain fluid in the bowel
• Stool softners - useful when managing painful anal conditions such as anal fissures

Question 5

When should you not use a stimulant laxative?

Answer 5

In obstruction or acute colitis

Question 6

During a PR exam on a patient complaining of constipation, what might be a sign of a defecatory disorder?

Answer 6

Paradoxical contraction of the puborectalis and external anal sphincter during straining.

Question 7

name some general causes of constipation?

Answer 7

• Poor diet +/- lack of exercise
• Poor fluid intake/ dehydration
• IBS
• Old age
• Post operative pain
• Psychological fear of using the toilet.

Question 8

Name some anorectal diseases?

Answer 8

Should be thought of if presentation includes pain.

• Anal or Colorectal Cancer!!!!!
• Fissures/stricture/herpes
• Rectal prolapse
• Proctalgia Fugax / levator ani syndrome/ pelvic muscle dysfunction.
• Mucosal ulceration/neoplasia

Question 9

Name some causes of intestinal obstruction?

Answer 9

• Colorectal cancer!!!!
• Strictures → eg. crohn’s disease
• pelvic mass → eg. fibroids, fetus.
• Diverticulosis
• Hernia
• Volvulus
• Impacted faeces

Question 10

Name some metabolic causes of constipation?

Answer 10

• Hypercalcaemia
• Hypothyroidism (although rarely presents with constipation).
• Hypokalaemia.
• Porphyria
• Lead poisoning

Question 11

Name some drugs that can cause constipation?

Answer 11

• Opiates
• Anticholinergics → tricyclics
• Iron
• Some antacids → eg. Aluminium
• Diuretics → eg. furosemide
• Calcium channel blockers

Question 12

Name some neuromuscular causes of constipation?

Answer 12

Characterised by slow transit from decreased propulsive activity.

• Spinal/pelvic nerve injury
• Aganglionosis → chagas disease, hirschprungs disease
• Systemic schlerosis
• Diabetic neauropathy

Question 13

Name some other causes of constipation?

Answer 13

• Idiopathic slow transit
• Idiopathic Megacolon
• Chronic laxative abuse (rare → normally diarrhoea)

Question 14

what is manometry?

Answer 14

Colonic manometry is a test to measure how well the muscles and nerves in the colon work.

Question 15

What is rectal interssusception?

Answer 15

Rectal prolapse