Dyschezia, tenesmus and constipation

Question 1

Define dyschezia

Answer 1

Difficult or painful defaecation +/- blood

Question 2

Define tenesmus

Answer 2

Excessive straining to pass stools

Question 3

What are causes of dyschezia?

Answer 3

• Colonic impaction- bones/tumour
• Perineal hernia and rectal diverticulum
• Rectal stricture
• Anal neoplasia
• Severe prostatomegaly
• Obstipation

i.e mainly lesions near the anal region

Question 4

What are causes of tenesmus?

Answer 4

• Colitis
• Bone ingestion
• Rectal/anal tumours
• Post operatively following perineal surgery
• Prostatomegaly

Can lead to rectal prolapse

Question 5

What clinical signs are associated with colitis? How is it treated?

Answer 5

• Tenesmus
• Soft stools
• Mucus in stool
• Fresh blood
• Generally well animal

Treatment
- metronidazole
- suphasalazine - anti inflammatory for the colon
- high fibre feed
- steroids?

Question 6

What history questions should you ask when investigating constipation?

Answer 6

• When did it start?
• What is he/she passing?
• Is there any mucus/blood?
• Any change in diet or access to bones/fb?
• Are they eating?
• Any vomiting?
• Any trauma?
• Any weight loss?
• Any excessive licking of perineum or scooting?

Question 7

What should you include in your clinical exam when investigating constipation?

Answer 7

• Assess demeanour and hydration
• Start at nose and examine to tail
• Assess abdomen for any palpable gas or faecal excess-colon palpable in dorsocaudal abdomen
• Check temperature
• RECTAL EXAM- cats likely to require sedation/ga

Question 8

What further investigations can you undertake when investigating constipation?

Answer 8

• Rectal exam
• Abdominal Xray +/- contrast(barium enema)
• Ultrasound
• Colonoscopy
• CT
• Blood work- hydration, anaemia, wbcc, electrolytes, Tli/folate/cobalamin
• Urinalysis- some owners assume constipation when the animal is actually straining to urinate- esp cats

Question 9

What are possible treatments for constipation?

Answer 9

Cause dependent
- Laxatives - lactulosem liquid parrafin
* High fibre or low residue diets
* Metronidazole/sulphasalazine
* ENEMA-micro vs soapy water
* Surgery- Perineal herniorrhaphy
* Anal acculectomy-neoplasia
* Subtotal colectomy
* Rectal pull through
* Pelvic fracture repair

Question 10

What is feline idiopathic megacolon?What clinical signs are associated? How is it diagnosed? How is it treated?

Answer 10

Dilation of colon
Permanent loss of colonic structure and function

Clinical signs
RECURRENT CONSTIPATION
Hypomotility of colon

Diagnosis
1.5 x length of 7th lumbar vertebra

Treatment
Laxatives, enemas, high fibre feed
Subtotal colectomy