Post-Op Constipation Flashcards
What is constipation defined as?
A condition in which the patient has infrequent bowel movements (<3/week) often with hard, dry stools that may be painful and difficult to pass
What are the main causes of post-op constipation?
- Physiological
- Iatrogenic
- Pathological
- Functional
- Post-op ileus
- Bowel obstruction
What are the physiological causes of post-op constipation?
- Low fibre diet
- Poor fluid intake
- Low physical activity
What are the iatrogenic causes of post-op constipation?
- Opioid analgesia
- Anti-convulsants
- Iron supplements
- Antihistamines
What are the pathological causes of post-op constipation?
- Bowel obstruction
- Hypercalcaemia
- Hypothyroidism
- Neuromuscular disease
What are the functional causes of post-op constipation?
Painful defecation, e.g. anal fissures
How does constipation most commonly present?
Lower abdominal pain
How might constipation present in severe cases?
- Abdominal distention
- N&V
- Decreased appetite
What may be found on examination in post-op constipation?
Most patients will have no clinical signs on examination, and only severe cases are likely to have abdominal distention or tenderness
What is essential on examination for any patient with constipation?
DRE
What is true of most cases of post-op constipation, in terms of investigations?
They are benign in nature, and can be made as a clinical diagnosis, with no further investigations required
What might be required if there are features suggestive of a sinister underlying pathology with post-op constipation?
Endoscopy
What may be required in post-op constipation if no cause can obviously be identified or it is severe/resistant to treatment?
Routine bloods, such as TFTs and serum Ca
How can post-op constipation be managed in the vast majority of cases?
Conservative measures alone
What are the conservative measures for the management of post-op constipation?
- Adequate hydration
- Ensuring sufficient dietary fibre
- Treating underlying cause
- Early mobilisation
