Elderly: Constipation

Question 1

How is constipation defined?

Answer 1

<2 bowel actions per week, or less often than the persons normal habit

Passed with difficulty = straining, pain, sense of incomplete evacuation

Question 2

What causes constipation?

Answer 2

Poor diet, fluid intake

IBS

Anorectal disease = anal or colorectal cancer, fissures, rectal prolapse, mucosal ulceration

Intestinal obstruction = colorectal carcinoma, strictures (crohns), pelvic mass (foetus, fibroids), diverticulosis

Metabolic = hypercalcaemia, hypokalaemia, lead poisoning

Drugs = opioids, anticholinergics, iron, diuretics (furosemide), Ca channel blockers

Neuromuscular = spinal or pelvic N injury, systemic sclerosis, diabetic neuropathy

Other = chronic laxative abuse, idiopathic slow transit

Question 3

What symptoms and signs are associated with constipation?

Answer 3

Reduced bowel action

Straining

Pain

Tenesmus

Question 4

How should constipation be investigated?

Answer 4

Blood = FBC, ESR, U+Es, Ca, TFT

Sigmoidoscopy + biopsy

Barium enema + colonoscopy = if suspected malignancy

PR exam

Abdo exam

Question 5

How is constipation managed?

Answer 5

Drinking more

High fibre diet

Senna

Bulking agent = increase faecal mass, so stimulate peristalsis – must be taken with plenty of water

Stimulant laxative = increase intestinal mobility

Stool softeners = lactulose

Question 6

What are the possible complications of constipation?

Answer 6

Haemorrhoids

Anal fissures

Question 7

What common medications might impact adversely on bowel motions?

Answer 7

Opioids

Anticholinergics

Diuretics (furosemide)

Ca channel blocker