constipation and change in bowel habit

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common

causes: depression,immobility, idiopathic, Functional, inadequate dietary fibre

rare

a) metabolic: 1) Hypothyroidism, 2)Hypercalcaemia b)Drugs: 1)opiates, 2)Antidepressants, 3)Verapamil and other ca2+ blockers c)Neoplasia: 1)colon cancaer 2) Rectal cancer

clinical features

1) period of constipation , 2)Has the nature of the problem change 3) history 4)rectal bleeding 5)Dietary history 6) Drug history

E & I

a)blood test: 1)FBC, 2)ESR 3)thyroid function and calcium b) Barium Enema or CT colonography, c)Transit studies d)Anorectal physiology and defecating proctography

Managements

a) for reassurance b)Diet and hydration c)Laxatives= 1)stimulant laxative 2)bulk-forming laxative 3)osmotic laxative*

IN OLDER PATIENTS

Features suggestive of underlying pathlogy

Examination

Management

1)Anorexia and/weight loss 2)Nocturnal Diarrhoea /pain disturbing sleep 3)rectal bleeding

full physical examination mandatory, - lymphadenopathy, abdominal masses, organomegaly , rectal examination

Serious disease is sought from FBC, ESR iron indices, LFTs, Thyroid function, serum calcium. TO eliminate suspicion of colorectal cancer : colonoscopy, barium enema, ct colonography

History

obstetric in women, pelvic trauma during protracted labour,assisted delivery

Drug history- opioids,calcium antagonist, anticholinergics, iron supplements, calcium containing antacids

Stimulant laxative eg. SENNA , use for short term constipation due to dependant on drugs (especially during hospitalisation)

~bulk forming laxatives eg. FYBOGEL,ISOGEL. may exacerbate symptomatic bloating

~osmotic laxative (e.g MOVICOL, MgSo4) well tolerated, first line treatment over country tablets such as milk of magnesia, epsom salt, lactulose (may cause inconvenient colic and wind

often unrewarding

notes

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