What is constipation?
- Infrequent/Difficulty passing stools, usually defined as less than 3 times a week
What is chronic constipation?
Symptoms which are present for atleats 3 months
What other symptoms may present alongside constipation in elderly?
- Confusion/Delirium
- Nausea or loss of appetite
- Overflow diarrhoea
- Urinary retention
What are risk factors for constipation?
Social: Low fibre diet/calories, difficulty getting to the toilet, lack of mobility
Psychological: Anxiety/Depression, Eating disorders
Physical: Females, older age, pyrexia
What are secondary causes of constipation?
- Analgesics such as opiates
- Antimuscarinics/Antidepressants
- Antipsychotics
- Antiepileptics
- Endocrine: DM, electrolyte imbalances
- Neuro: MS, Parkinsons, Spinal injuries
How is constipation investigated?
- Check for any red flags
- DRE to assess tone/anal sphincter
How is constipation managed conservatively?
- Advice re balanced diet with gradual increase in fibre intake
- Ensure good fluid intake
- Helpful toileting advice
How is constipation managed medically?
1st line: Bulk forming laxatives which retain fluid within the stool e.g. Isphagula husk
2nd line: Osmotic laxative which help increase fluid in large bowel e.g. Lactulose/Macrogols
3rd line: Stimulant laxatives which help with peristalsis e.g. Senna, Bisacodyl
How to manage opioid-induced constipation?
- Use osmotic/stimulant laxatives
- Bulk forming laxatives should not be used
How do you manage faecal loading/impaction?
1st line: Suppository such as bisacodyl or glycerol
2nd line: Mini enema such as docusate
3rd line: Sodium phosphate enema
How should laxatives be stopped?
Weaned over weeks/months after regular bowel movements with soft stools have been established
