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Constipation

Introduction

Infrequent or difficulty in evacuating faeces. Remember that this is a relative term - what is 'normal' or 'regular' for one individual may be very different to that of another individual. It is therefore the change in an individual's bowel habit (in this case a decrease) that is important.

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Differential diagnosis

Bowel
Lumen
- decreased dietary fibre
- decreased fluid

Obstruction
- CRC
- Crohn’s strictures
- diverticular disease
- idiopathic megacolon
- Hirschsprung’s disease

Anorectal disease
- anal fissure
- rectal prolapse

Systemic
Common
- depression
- immobility
- functional (IBS)

Drugs
- opiates
- anticholinergics (TCA...)
- iron
- verapamil

Metabolic
-­ Ca ²⁺
- decreased K ⁺
- decreased T4 (hypothyroidism)

Neuromuscular
- spinal cord injury
- systemic sclerosis
- autonomic neuropathy

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Investigation

Bloods
- FBC
- U&Es
- Ca²⁺
- TFTs (thyroid function tests)

Imaging
- Barium enema

Special
- flexible sigmoidoscopy +/- biopsy
- bowel transit studies
- anorectal physiology

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Management

1st-line
- dietary advice (increased fibre & fluids)
- treat cause (exclude obstruction)

Laxatives
- bulk-forming: Ispaghula husk (Fybogel)
- stool-softeners: arachis oil enemas
- osmotic: lactulose , sodium picosulphate, phosphate enemas

Stimulant
- senna

Surgery
- last resort

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