Constipation

Question 1

Causes of constipation

Answer 1

Hard faeces - low fibre, dehydration
IBS
Post op ileus
Obstruction - stricture, colorectal carcinoma, diverticulitis
Anorectal disease - fissures, prolapse
Endocrine - hypercalcaemia, hypothyroidism
Drug - opioid, iron tablets, anticholinergics
Spinal cord damage
Chronic laxative abuse

Question 2

Investigations

Answer 2

Exam for fissures and haemorrhoids 
DRE - hard stool do plain AXR, empty rectum do flexible sigmoidoscopy 
Hb
TFTs
Calcium

Question 3

Treatment for hard stool

Answer 3

Increase fluid intake
Consider long course of macrogol (osmotic laxative)
Faecal softener e.g docusate or glycerol
AVOID STIMULANT LAXATIVES - risk of perforation

Question 4

Treatment for soft stools

Answer 4

Stimulant laxative e.g phosphate enema acutely and senna long term