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Constipation

Definition
  • A common digestive issue where individuals have infrequent bowel movements, and/or hard, dry stools. It’s often accompanied by abdominal discomfort.
Epidemiology
  • Prevalence varies globally, affecting up to 20% of the population.
  • More common in females, the elderly, and those with a low dietary fibre intake.
Clinical Features
  • 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.
Causes
  • 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.
Investigations
  • Initial: Full blood count (exclude anaemia), calcium, thyroid function tests.
  • 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.
Management
  • 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.
Complications
  • Haemorrhoids and anal fissures due to straining.
  • Faecal impaction and overflow incontinence.
  • Rectal prolapse.

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