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Constipation

From Mediwikis

Unsatisfactory defecation because of infrequent stools, difficult stool passage, or seemingly incomplete defecation. If a person continues to complain about constipation after a discussion of what is normal and what is abnormal (especially with respect to frequency), they are asking for help in managing their problem, and should be regarded as having (symptoms of) constipation.

Functional constipation is diagnosed by excluding the drug and medical causes of secondary constipation.

Normal bowel habit in adults is not necessarily between 1 stool every 3 days, or 3 stools per day, as widely quoted, but whatever is regular for them.

In Children

Normal pattern:

  • Infants- 2 to 4 stools per day; breast fed infants may have some delay initially
  • By age 4, normal adult pattern begins

Symptoms

  • Painful defecation
  • ↓ frequency of stool
  • Soiling- overflowing liquid stool

Red Flags

  • No meconium for 24 hours
  • Weight Faltering
  • Abdominal Distension
  • Neurological problems, sacral dimple (spina bifida)

Causes

Management

  • Reassurance
  • Mild constipation:
    • Laxatives, more fluid intake
  • Longstanding:
  • Stool softeners
  • Laxatives

Adults

Red Flags

History

  • Rectal bleeding for >6 weeks
  • Change in bowel habit (looser stools and/or more frequent stools) for >6 weeks without rectal bleeding

Examination/Investigation

  • Right abdominal mass (consistent with involvement of the large bowel)
  • Palpable rectal mass
  • Unexplained iron deficiency anaemia

Examination

  • Digital rectal - if red-flagged- not in children

Investigation

  • Sigmoidoscopy - if red-flagged
    • Exclude cancer and diverticular disease
  • Barium enema - if red-flagged
  • Colonoscopy - if red-flagged

Management

  • Causal
  • Exercise
  • Good fluid intake
  • High fibre diet
  • Drugs
    • Stimulant laxatives (e.g. - Senna)
    • Bulking agents (e.g. - Bran)
    • Stool softeners - for painful anal conditions
    • Osmotic laxatives (e.g. - lactulose)