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Constipation

Overview

  • Constipation is commonly a result of poor diet and sedentary lifestyle, however it may also signal underlying gastrointestinal or non-gastrointestinal pathology. History-taking can aid in dividing these differential diagnoses and narrowing in on a cause.

Aetiology

    • Causes of Constipation

    • Primary

    • Functional Constipation
    • Colorectal

    • Faecal impaction
    • Colorectal cancer
    • Strictures - diverticular disease, ischaemia, IBD, radiation
    • Volvulus
    • Prolapse - rectocoele, enterocoele
    • Anorectal disorders - fissure, fistula, ulcer, large haemorrhoids
    • Motility disorders - slow transit bowel, irritable bowel syndrome
    • Non-Colorectal

    • Lifestyle factors - poor diet, physical inactivity, increased age
    • Medications - opioids, NSAIDs, ondansetron, anticholinergics, diuretics, antiepileptics, antacids, iron supplements, calcium supplements, calcium channel blockers
    • Metabolic / endocrine - hypercalcaemia, hypokalaemia, uraemia, diabetes, hypothyroidism
    • Neurological - stroke, Parkinson’s disease, MS, spinal cord trauma, Hirschprung disease
    • Connective tissue disorders - amyloidosis, scleroderma
    • Psychogenic - anxiety, depression, anorexia nervosa
    • Pregnancy

History of Presenting Complaint

    • Stools

    • The colour and consistency of the patient's stools.
    • Onset

    • Whether the constipation started suddenly or gradually, and in what situation.
    • Timing

    • Frequency of stools, and whether the patient passes any normal  or loose stools between episodes of constipation.
    • Associated Symptoms

      Whether the constipation is associated with any other symptoms.
    • Abdominal painNonspecific feature of many GI causes
    • Sharp anorectal pain on passing stoolsSuggestive of anal fissure
    • Abdominal BloatingSuggestive of irritable bowel syndrome
    • Blood stained stoolsRed flag for colorectal cancer, diverticulitis or IBD
    • Blood on toilet paperSuggestive of haemorrhoids or anal fissure
    • Episodes of incontinenceSuggestive of overflow incontinence secondary to obstruction
    • Weight lossRed flag for colorectal cancer
    • Faeculant vomitingSerious indicator of bowel obstruction
    • Exacerbating Factors

    • Whether there is anything that makes the consipation worse.
    • Alleviating Factors

    • Whether there is anything that improves the constipation, and whether they have had any improvement with apperients.

Extra Credit

  • The Rome III criteria are used for the diagnosis of functional constipation. The criteria must be present for the last three months, with symptom onset at least 6 months prior to diagnosis.
    • Rome III Criteria

    • Diagnostic Criteria - ≥2 present

    • Straining while defaecating at least 25% of defaecations
    • Lumpy or hard stools at least 25% of defaecations
    • Sensation of incomplete evacuation for at least 25% of defaecations
    • Sensation of anorectal obstruction or blockage for at least 25% of defaecations
    • Need for digital maneuvers to evacuate stool at least 25% of defaecations
    • Less than three defaecations per week
    • Additional Criteria

    • Loose stools rarely present without the use of laxatives
    • Insufficient criteria to indicate irritable bowel syndrome
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Associated Diseases
BETA

Gastrointestinal
Inflammatory Bowel Disease
Neurological
Nutrition & Metabolic
Psychiatry
Other

Associated Drugs
BETA

Cardiovascular
QuinidineProcainamide
Calcium Channel Blockers
Spironolactone
Loop Diuretics
Hydrochlorothiazide
Other
Analgesic Agents
Opioids
Drug & Alcohol
Atropine
Endocrine
Teriparatide
Immunology
Basiliximab
Infectious Diseases
M2 Inhibitors
Oncology
Vinca Alkaloids
Anti-EGFR (HER1)
Psychiatry
Doxepin
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