ABSTRACT
Constipation There is often a disparity in the understanding of the word ‘constipation’ between doctors and patients. It is often used by patients to describe painful hard stools or the sensation of incomplete emptying rather than the medical defi nition of an infrequent passage of stools (<3/week). It is always important to clarify the patient’s own understanding of the word ‘constipation’ before going down the path of misdiagnosing and mistreating. Treatment is important in order to avoid complications (pain, bowel obstruction, overfl ow diarrhoea, urinary retention)
Causes of Constipation Dietary Dehydration, lack of fl uid intake, poor diet (low fi bre) Drugs Opioids, diuretics, aluminium antacids, iron and
calcium supplements, anticholinergics (TCAs), calcium channel blocker
Bowel Bowel obstruction (abdominal pain, distension, vomiting, tinkling bowel sounds), colon carcinoma (abdominal pain, weight loss, PR blood, mass),
diverticular disease, stricture, irritable bowel syndrome
Anal Anal fi ssure (perianal tags), haemorrhoids (fresh PR blood on toilet paper, pain)
Endocrine Hypothyroidism, hypokalaemia, hypercalcaemia Neuro. Spinal cord injury, autonomic neuropathy
their frequency, quality and quantity. Identify the presence of altered bowel habits. Ask about episodes of loose stools in between periods of constipation (overfl ow diarrhoea).
