Constipation.

 

Definition:

Constipation refers to unsatisfactory evacuation because of infrequent stool passage, difficult stool passage or seemingly incomplete defecation. It occurs when the content of the large intestine move slowly, and more water is absorbed from the matter than is normal. Stools become more compact and harder, which therefore also slows their passage through the gastrointestinal tract.

 

 

Causes:

There are several causes of constipation. It may result from a lack of fibre in the diet,

lack of exercise, not drinking enough, medication (for example opiates such as codeine),

IBS, pregnancy or possibly cancer.

 

 

Presentation:

A patient is likely to complain that they are not passing stools as often as usual, and that

they are having to strain to do so. In addition, they may feel that they cannot empty their

bowels completely. Usually, not passing stools for at least 3 days is defined as

constipation.

 

Patients may feel pain and difficulty when passing stools, abdominal discomfort and also

suffer from wind and stomach cramps.

 

 

Differential Diagnosis:

Exclude a more serious underlying cause by checking there is no blood in the stools and that the patient has not lost weight unintentionally- these could be indications of colon cancer.

 

Ensure it is not alternating diarrhoea and constipation- could be a sign of IBS.

 

Check whether there has been any foreign travel- could be related.

 

If a patient is under 10 years, on other medication which may be causing the constipation (e.g. antispasmodics, diuretics), if this is a recurrent problem or if the problem has lasted over a week they should be referred to the doctor.

 

 

Treatment:

Stimulant laxatives (e.g. Senna) can be used to help stimulate nerve endings in the bowel to promote

movement of faeces. Adults should take ONE or TWO tablets at night to have an effect in the morning.

 

Bulk forming laxatives may be recommended to increase the mass of the faeces, which enourages the

intestine to move faster (e.g. Ispaghula husk). Bulk forming laxatives usually work within 24- 36 hours

and should always be taken with plenty of water. Senokot Hi-fibre Orange sachets should be stirred

into a glassof water, ONE in the morning and ONE in the evening after dinner.

 

Osmotic laxatives work by keeping fluid in the bowel and faeces, making them easier to pass

(e.g. macrogol). Movicol sachets should be dissolved in 125ml of water ONE to THREE times daily

dependent on the individuals response.

 

Lastly, faecal softeners (e.g. glycerin suppositories) work by lubricating the faeces and making them

easier to pass. Care Glycerin Suppositories should be dipped in water before insertion into rectum.

 

 

Self Help Advice:

Remind patient to eat plenty of fruit and veg, raw if possible, and wholegrain foods.

 

Drink plenty of fluids throughout the day to stay hydrated.

 

Take regular exercise (tailor this to patient, for example elderly patients could walk to a local shop, or do

some gardening- it doesn't have to be running!)

 

Avoid 'holding back' the urge to defecate as this can exacerbate the issue.

 

Remember the change in diet/ excerise won't work instantaneously- give it time to work.

 

 

Sample Question:

Select whether the following 2 statements are true or false:

 

a) Over 700 drugs may cause constipation

b) Tramadol is a drug which may cause constipation

 

Answers to all sample questions can be found by following the link under the Test Yourself tab.