Constipation

Question 1

What is the definition of constipation?

Answer 1

Infrequent passage of stool (<3/week).

Question 2

What is this a presentation of?
Generalised abdominal pain, anorexia, infrequent bowel movements, straining, passage of small hard stool, blood (if anal fissure), can have overflow diarrhoea.

Answer 2

Constipation

Question 3

What are the causes of these aetiologies for constipation?

1. Presence since birth
2. Meconium ileus
3. Failure to thrive
4. Abnormal spine/weak legs

Answer 3

1. Structural congenital anomaly
2. CF, Hirschsprung’s
3. Coeliac, hypothyroidism, CF
4. Spina bifida

Question 4

How is constipation investigated?

Answer 4

1. Clinical diagnosis
2. Plot growth chart
3. Abdominal exam - large faecal mass LIF
4. TFTs for hypothyroidism, coeliac screen
5. Inspect anus for fissures
6. Neurological exam of lower limbs to exclude spinal pathology
7. Consider OGD and colonoscopy under GA

Question 5

What is the management for paediatric constipation?

Answer 5

1. Idiopathic - increase fibre and fluids
2. Macrogol laxatives (Movicol paediatric plain) are 1st line (bulk-forming)
3. Add stimulant laxative (Senna) if no response
4. May need a laxative disimpaction regime.