Constipation, Hemorrhoids, IBS

Question 1

Constipation
-possible causes

Answer 1

Functional - lack of fibre, inadequate fluids, sedentary
Medication induced - opioids, antacids, antidepressants (SSRI, TCA)
Hypothyroidism
Parkinsons
Colorectal cancer
IBS

Question 2

Haemorrhoids
-pathophysiology
-risk factors
-presentation
-investigations
-management

Answer 2

Increased pressure in blood pressure and around anus => swollen and inflammed blood vessels
-prolonged constipation => straining
-overweight, pregnant
-age
-sedentary
-regularly lifting heavy objects

Rectal bleeding +- pain
Itch
Sore, red, swelling around anus

Internal/external exam

Soften stool - increase dietary fibre and fluid
Symptom relief - TOP local anaesthetics, steroids
If severe - rubber band ligation, surgery

Question 3

Irritable bowel syndrome
-pathophysiology
-presentation
-management

Answer 3

Multifactorial - genetic, environmental
-altered brain gut axis
-low grade inflammation
-neurotransmitter imbalance
Result in altered motility, visceral hypersensitivity, pain perception

ABC
-abdo pain
-bloating
-change in bowel habit

Diagnosis made if
Recurrent abdo pain for at least 1 day/week for past 3 months
Pain linked to 2 of the 3
-defecation, pain relieved/worsened by bowel movements
-frequency of stool change
-frequency of stool form
Symptom onset 6 months before diagnosis

1st line according to predominant symptom
-pain - antispasmodics
-constipation - laxatives except lactulose (increases gas)
-diarrhoea - loperamide
2nd line - amitriptyline
If no response to meds after 1 year => CBT, hyponotherapy

General dietary advice
-regular meals
-plenty of fluid (restrict caffeine, alcohol, fizzy drinks)
-limit intake of high fibre food, resistant starch, fresh fruit