Constipation

Question 1

Drugs

Answer 1

Opiates - morphine and codeine 
antidepressants 
antiepileptics 
antacids 
phenytoin

Question 2

Red flags

Answer 2

onset < 12m 
delayed passage of meconium 
not stool withholding 
no soiling 
intermittent diarrhoea and explosive stools
FTT 
empty rectal ampulla 
tight anal sphincter 
gushing of stool with rectal exam 
abnormal neurological exam 
pigmentary abnormalities 
heme positive stools 
extra intestinal symptoms 
bladder disease 
no response to conventional treatment

Question 3

Disimpaction

Answer 3

vital before initiation maintenance therapy
oral
- mineral oil 15-30ml/year of age up to 240ml
- PEG 1.5g/kg/day
Golytely 25ml/kg/hr
Pegicol/Movicol 1.5g/kg/day (2-6 sachets/day) for 3 d
- phosphate enemas, glycerine suppository (ST use only)

Question 4

Maintenance therapy

Answer 4

goal: Daily soft painless stools preventing the reaccumulation of faeces
- osmotic laxatives - lactulose or PEG 3350
- mineral oil - lubricant and hydroxy fatty acids
- stimulant laxatives - Senna,

Behavioural modification
dietary measures