Constipation

Last updated 20.09.12

 

Definition

-  <3 stools passes per week

-  Functional: <2 bowel motions/week ass w straining >25% of time, tenesmus 25% of time & hard lumpy stools

 

Features

-  Normal frequency varies from 3/day to 3/week

-  Most common digestive complaint

-  Increaesd incidence in >60yrs & women

 

Associated S/S

-  Abdo pain

-  May be associated with UTI in children

-  Obstipation (no stool or wind): bowel obstruction

-  Haematochezia: haemorrhoids, bowel Ca

-  Weight loss: bowel Ca

-  Nausea, vomiting: bowel obstruction

-  Anorexia

 

Complications

-  Haemorrhoids

-  Anal fissures

-  Megacolon

 

Causes

-  Idiopathic

-  ?Pelvic floor dysfunction

-  ?Slow colonic transit

-  Bowel obstruction

-  Depression

-  Hypothyroidism

-  Hypercalcaemia

-  Hirschsprungs

-  Olgivies syndrome

-  DM

-  Spinal cord injury

-  Medications

-  Iron

-  Calcium

-  Opiates

-  Anticholinergics

-  Antacids

-  Verapamil

-  Pregnancy (esp if Rx w Iron)

 

DDx

-  IBS

 

Ix

-  +/- PR exam

-  Faecal impaction

-  Haemorrhoids

-  Mass: bowel Ca

-  Blood: bowel Ca, haemmorrhoids

-  Tone: spinal cord injury, CNS disorder

-  Strictures

-  Prolapse

-  +/- TFT: hyperthyoidism

-  +/- CMP: hypercalcaemia

-  +/- FBE if significant haematochezia: anaemia

-  +/- AXR

-  Faecal loading

-  Bowel obstruction

-  Bowel Ca

-  Megacolon

-  +/- Colonoscopy

-  Consider in all pts >50yrs & nil previous screen for Bowel Ca or anaemia

 

Mx

-  Diet = 1st line

-  Adequate hydration

-  Adequate fiber: 20-35g/day

-   Some types of fiber may aggravate IBS S/S

-  Avoid coffee

-  +/- prunes

-  Exercise

-  Decreases bowel transit time

-  Stimulates regular movements

-  Technique

-  Lean forward, straight back

-  Knees above hips

-  Defecate post meals

-  Laxatives

-  Once bowel clear cease laxatives

-  Use in consecutive order

-   Bulk forming: Isphagula, Psyllium

-   Osmotic: Lactulose, PEG

-   Stimulant: Senna (+ Coloxyl)

-   Suppositories

-  Disimpaction

-  +/- Gastrograffin enema

-  Pregnancy

-  Fiber supplements

-  Osmotic laxatives

-  Avoid magnesium & stimulant laxatives

 

Position

 

 

 

References

 

Upto Date: Mx of Constipation in Adults, Walk et al, 11/10/11

Upto Date: Etiology & Evaluation of Chornic Constipaton in Adults, Wald et al, 28/02/12

Pic: aihealth.blogspot.com.au/2008/05/squatting-good-for-your-insides-faster.html