Constipation

A common digestive issue where individuals have infrequent bowel movements, and/or hard, dry stools. It’s often accompanied by abdominal discomfort.

• Prevalence varies globally, affecting up to 20% of the population.
• More common in females, the elderly, and those with a low dietary fibre intake.

• Primary: Often related to diet, lifestyle, or idiopathic slow transit.
• Secondary: Medications (e.g., opioids, anticholinergics), metabolic (e.g., hypothyroidism, hypercalcaemia), neurological (e.g., Parkinson’s disease), structural (e.g., colorectal cancer), and psychogenic causes.

• Bowel-related symptoms: Infrequent stools, straining, sensation of incomplete evacuation, hard or lumpy stools.
• Abdominal discomfort or pain.
• Systemic symptoms: Nausea, bloating, loss of appetite.
• Faecal impaction may lead to overflow diarrhoea.

• Full blood count (to exclude anaemia).
• Calcium levels.
• Thyroid function test.

• Abdominal X-ray: If faecal impaction is suspected.
• Colonoscopy or sigmoidoscopy: If there’s suspicion of colorectal cancer or inflammatory bowel disease.
• Anorectal manometry: To evaluate for Hirschsprung’s disease or anismus.

• Initial management involves lifestyle and dietary modifications:
  • Increased dietary fibre intake.
  • Adequate fluid consumption.
  • Regular exercise.
• Laxatives: Bulk-forming (e.g., ispaghula husk), osmotic (e.g., lactulose, macrogols), stimulant (e.g., senna), stool softeners (e.g., docusate).
• For faecal impaction: Manual disimpaction or higher doses of osmotic laxatives.
• Treat underlying causes, if identified.

• Haemorrhoids and anal fissures due to straining.
• Faecal impaction and overflow incontinence.
• Rectal prolapse.

• Constipation is a common digestive issue characterised by infrequent bowel movements, and/or hard, dry stools.
• Investigations are used to assess for faecal impaction and possible underlying causes such as colorectal cancer and IBD.
• Management primarily involves lifestyle and dietary modifications, with possible laxative treatment and manual disimpaction for faecal impaction.
• Appropriate management and patient compliance to lifestyle modifications is crucial to prevent complications, such as faecal impaction.