Constipation

Question 1

What are most cases of constipation described as?

Answer 1

Idiopathic constipation / functional constipation

Could be a behavioural issue.

Question 2

What are some secondary causes of constipation?

Answer 2

Hirschsprung disease, CF, hypothyroidism

Question 3

What could be some causes of constipation?

Answer 3

Toilet training, school toilets, diet/exercise

Question 4

What are some lifestyle factors contributing to constipation?

Answer 4

• habitually not opening the bowels
• low fibre diet
• poor fluid intake and dehydration
• sedentary lifestyle
• psychological problems eg. difficult home or school environment

Question 5

What are some red flags for constipation?

Answer 5

• if they’re constipated and not thriving
• from birth
• failure to thrive
• vomiting (intestinal obstruction, hirschsprung’s)
• not passed meconium (CF, hirschsprungs)
• abnormal lower back/buttocks
• any neurological symptoms/signs

Question 6

What is the presentation of constipation?

Answer 6

• < 3 stools a week
• hard stools that are difficult to pass
• rabbit dropping
• straining and painful passage of stools
• abdominal pain
• holding an abnormal posture = retentive posturing
• rectal bleeding with hard stools
• faecal impaction causing overflow soiling
• hard stools may be palpable in abdomen
• loss of sensation of the need to open bowels

Question 7

Why should you inspect the anus in cases of constipation?

Answer 7

To look for any infections, fissures, fistulas or bruising

Perianal group A streptococcal infection causes pain and erythema at the anus, which could cause constipation (treated with penicillin V).

Question 8

What is the management for constipation?

Answer 8

• correct any reversible contributing factors
• high fibre diet and hydration
• laxatives - macrogol laxatives (movicol), stimulate laxatives (senna)
• faecal impaction may need disimpaction regiment with high dose of laxatives
• encourage and praise visiting the toilet - scheduling visits, bowel diary and start charts