Constipation

Question 1

Define constipation.

Answer 1

<2 movements per week which are painful, require straining and are followed by a sense of incomplete evacuation.

Question 2

What questions should you ask when inquiring about constipation?

Answer 2

Frequency? Nature? Consistency? Blood/mucus? Any diarrhoea? Change in bowel habit? Diet? Drugs?

Question 3

What are the possible causes of constipation?

Answer 3

GI: colorectal/anal carcinoma, fissures and strictures, pelvic mass e.g. fibroids, diverticulosis, prolapse, pelvic muscle dysfunction.
Neuromuscular: Diabetic neuropathy, systemic sclerosis, hirschsprung disease.
Drugs: Opiates, iron, tricyclics, furosemide, Ca2+ channel blockers.
Poor diet and fluids.
Hypercalcaemia, hypokalaemia.

Question 4

What are the red flags for constipation?

Answer 4

Weight loss, anaemia, bleeding, abdo mass.

Question 5

What investigations are performed for constipation?

Answer 5

Not normally needed in young people who are mildly affected.
Investigate possible causes depending on history e.g. ESR, FBC, Ca2+.
Colonoscopy if suspected malignancy.

Question 6

What advice should be given to someone suffering from constipation?

Answer 6

If not an organic cause, offer lifestyle advice then medication:

• Increase fluid intake, avoid alcohol, more exercise, increase fibre in diet.
• Offer laxatives - often a stimulant laxative (senna) +/- bulking agent (fybogel) is more effective than an osmotic agent (lactulose).