Gastro - Constipation Flashcards
What needs to be considered when managing constipation?
How often bowels are opened varies
Breast-fed babies have 1 stool per week
An individual opening bowels 2-3 times in a week may be constipated for them
What are the typical features from a history which indicate constipation?
Rabbit dropping stools
Hard stools, difficult to pass
Less than 3 stools a week
Straining and painful
Abdominal pain
Retentive posturing
Rectal bleeding with hard stools
Overflow soiling
Hard stools palpable in abdomen
Loss of sensation of need to open bowels
What is encopresis?
Faecal incontinence
Not pathological until 4 years old
What does encopresis indicate?
Chronic constipation
What happens in encopresis?
Rectum becomes stretched and loses sensation
Large hard stools remain and loose stools bypass blockage and leak out
Causes soiling
What are some rare causes of encopresis?
Spina bifida
Hirschsprung’s disease
Cerebral palsy
Learning disability
Psychological stress
Abuse
What lifestyle factors contribute to constipation?
Low fibre diet
Poor fluid intake and dehydration
Not opening bowels regularly
Sedentary lifestyle
Psychosocial problems
What psychosocial problems can contribute to development of constipation?
Difficult home environment
Difficult school environment
SAFEGUARDING
What can cause desensitisation of the rectum?
Habitually ignoring sensation of full rectum
Lose sensation to needing to open bowels and open their bowels even less
Retain faeces in their rectum leading to impaction
Over time the rectum stretches as it fills more leading to further desensitisation
The longer it continues, the more difficult to treat
What are some secondary causes of rectum desensitisation?
Hirschsprung’s
CF (particularly meconium ileus)
Hypothyroidism
Spinal cord lesions
Sexual abuse
Intestinal obstruction
Anal stenosis
Cow milk intolerance
What are the Red Flags with constipation?
Not passing meconium within 48 hours- CF or Hirschsprung’s
Neurological signs or symptoms, particularly in lower limbs - cerebral palsy or spinal cord lesions
Vomiting- intestinal obstruction or Hirschsprung’s
Ribbon stool- anal stenosis
Abnormal anus- anal stenosis, IBD or sexual abuse
Abnormal lower back or buttocks- spina bifida, spinal cord lesion or sacral agenesis
Failure to thrive- Coeliac disease, hypothyroidism or safeguarding
Acute severe abdominal pain and bloating- obstruction or intussusception
What are the complications of constipation?
Pain
Reduced sensation
Fissures
Haemorrhoids
Overflow and soiling
Psychosocial mobility
How is constipation managed?
Idiopathic constipation can be made without investigations
Explain that treatment can be a long process, potentially lasting months
Reassurance
- Correct reversible factors, high fibre diet, hydration etc
- Start laxatives
- Faecal impaction may require dis-impaction regimen, high doses of laxatives at first
- Encourage and praise going to toilet
What laxative is first line for children?
Movicol
How do you encourage children to go to the toilet?
Scheduling visits
Bowel diary
Star charts
