A condition characterised by hardened faeces and difficulty emptying the bowels
Causes
- Dietary: lack of roughage, inadequate fluid intake
- In infants: concentrated feeds
- Lack of exercise, bedridden patient especially in elderly
- Pregnancy
- Certain drugs e.g. narcotic analgesics, antidepressants, diuretics, antipsychotics, iron
- Colon or anorectal disorders : stricture, cancer, fissure, proctitis , congenital bowel abnormalities, irritable bowel syndrome, volvulus, intussusception
- Metabolic : hypercalcemia, diabetes, hypothyroidism
- Neurological disorders: spinal cord lesions, stroke, Parkinsonism
Clinical features
- Abdominal discomfort
- Small hard stools passed irregularly under strain
- Can cause haemorrhoids and anal fissure
Alarm features
- Symptoms and signs of intestinal obstruction or acute abdomen
- Confusion/disorientation
- Abnormal vital signs
- Iron deficiency
- Rectal bleeding or haematochesia or rectal mass
- Haem postive stool
- Patients > 45 years with no previous history of colon cancer screening
- History of colon cancer in immediate family relatives
- Weight loss
Investigations
- Physical examination
- Abdominal mass and tenderness
- Anorectal examination (faecal impaction, stricture, rectal prolapse, rectal mass)
- Stool examination
Investigations for patients with alarm features
- Abdominal series (supine, upright, left lateral decubitus)
- Transabdominal ultrasound
- Endoscopy
- Complete blood count, renal function tests, serum calcium, thyroid function tests, blood sugar
- Barium enema +/- CT scan or X-ray
Management
No alarm features or chronic constipation
- High dietary fibre
- Adequate fluid intake
- Bisacodyl: Adult 10 mg at night. Take until stool is passed
Child 5-12 years: 5 mg (suppository only)- Contraindicated in acute abdomen as it aggravates the condition
- Oral or rectal lactulose (osmotic agent). Provides faster relief than bisacodyl
If alarm features or severe chronic constipation are present
- Refer to hospital for specialist management
Prevention
- Diet rich in roughage – plenty of vegetables and fruit
- Plenty of oral fluids with meals
- Increased exercise