Constipation
Gastroenterology (12%) Core Clinical Conditions
1A: Able to diagnose and manage
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Definition Aetiology Pathophysiology Risk factor Sign and Symptoms Investigations Management
Definition
Constipation is a common digestive issue that affects many individuals worldwide. It is characterised by infrequent bowel movements and difficulty passing stool.
Aetiology
lack of physical activity
Inadequate fluid intake
Diet low in fibre and high in processed foods.
Certain medications, such as opioids and some antidepressants.
Hypothyroidism and irritable bowel syndrome (IBS) may further exacerbate constipation.
Pathophysiology
When we eat, food is broken down in the stomach and small intestine, and nutrients are absorbed.
The remaining waste then moves into the large intestine or colon, where water is absorbed, and stool is formed.
Muscular contractions, known as peristalsis, help propel the stool towards the rectum. In constipation, this process is disrupted, resulting in slower transit time and drier stool consistency.
Risk factors
Age: caused by age-related changes in the digestive system.
Female: during pregnancy, caused by hormonal changes and pressure on the intestines.
Some medical conditions e.g. parkinson's disease, multiple sclerosis (MS), and diabetes.
Sign and symptoms
Bowel movements that occur less than three times per week.
Sometimes accompanied by straining or a sensation of incomplete evacuation.
Abdominal pain, bloating, and a feeling of abdominal heaviness.
Diagnosis and investigations
Excellent medical history and examination.
Bloods: FBC, TSH to rule out hypothyroidism, U&E to rule out hypercalcemia and dehydration, CRP/ESR.
Abdominal X-rays or abdominal ultrasound.
Colonoscopy.
Management
Increase fibre-rich foods like fruits, vegetables, and whole grains.
Laxatives may be prescribed to alleviate constipation:
Bulk-forming laxatives: these laxatives contain fibre and promote bowel movements by absorbing water in the intestines, softening the stool, and increasing stool bulk. Psyllium husk is an example.
Stool softeners, also known as emollient laxatives, assist in moistening and lubricating the stool to make it easier to pass. Sodium docusate is a common stool softener.
Osmotic laxatives work by drawing water into the intestines, which softens stool and promotes bowel movements. Lactulose is an example.
Stimulant laxatives: Stimulant laxatives increase bowel movements by stimulating the muscles of the intestines. Typically, they are prescribed for temporary relief. Senna is an example.
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