Constipation

Differential diagnosis

  • Obstruction – abdo pain, distension, vomiting, prev abdo surgery
  • Bowel Ca – weight loss, PR bleeding, FH
  • Medications – opiates, PPIs, iron/calcium supplements, calcium channel blockers
  • UTI
  • Dietary – low fluid/fibre

 

Data gathering

  • History – as above
  • Examine – abdominal, PR

 

Clinical management

  • Investigations
    • Bloods – FBC, U+E, LFTs, Calcium, TFTs
  • Explanation
  • Treatment
    • Lifestyle
      • Fibre, fluids (2L water), keep active, toileting routines
    • Medications
      • 1st line: Fybogel (bulk forming laxative – avoid if opiate induced constipation)
      • 2nd line: Macrogol (osmotic laxative)
      • 3rd line: Bisacodyl (stimulant laxative)
        • nb: stimulants should ideally be given at night as it takes 8-10 hours to reach the colon after administration
      • Impacted faeces
        • Arachis oil enemas
  • Followup / Safety-net
    • continue medication at maintenance dose for several weeks after regular bowel habit is established – this may take several months
    • if no improvement despite the above, consider referral

Reference