Constipation

Question 1

What changes occur with ageing to the bowel?

Answer 1

Large bowel:
Peristaltic speed reduced
Peristaltic strength reduced 
Reduced mucosal strength- diverticula 
Reduced rectal sensation 
Small bowel:
Reduced absorption of some nutrients 
Decreased motility 
Other functions well preserved

Question 2

Which disincentives to regular voiding can lead to constipation?

Answer 2

• Poor access to facilities
• Lack of privacy
• Reduced mobility
• Change in routine

Question 3

Which medical problems can lead to constipation?

Answer 3

Bowel strictures
Carcinomas
Anal fissures
Prolapse

Question 4

Which drugs slow peristalsis?

Answer 4

Opiates
Iron supplements 
Calcium channel blockers
Antidepressants
Antipsychotics 
Anticholinergics

Question 5

What are the metabolic and endocrine causes?

Answer 5

Hypercalacaemia

Hypothyroidism

Question 6

What are the neurogenic causes?

Answer 6

Multiple sclerosis
Parkinson’s
Spinal cord pathology

Question 7

What are the associated symptoms of constipation?

Answer 7

Reduced mobility
Falls
Confusion
Problems with bowel or bladder function

Question 8

What are the investigations for constipation?

Answer 8

DRE- rectal masses, distal constipation, faecal impaction (haemorrhoids, rectal bleeding, anal tone, anal fissures)
FBC, U&E, calcium, TFTs
Abdo X-ray- rule out bowel obstruction and assess proximal constipation
Colonoscopy, CT abdomen, barium enema

Question 9

What is the management for constipation?

Answer 9

Before prescribing laxatives, it is important to rule out an obstructive cause

• Docusate – which is a stimulant and softener
• Combination therapy of a stronger softening agent such as macrogol and a strong stimulant such as senna is often used.