Constipation in Adults

Question 1

What are features of it?

Answer 1

Infrequent bowel movements <3 times per week
Straining
Hard or lumpy stools
Sensation of incomplete evacuation

Question 2

What is the management of constipation lasting <3 months?

Answer 2

1) Investigate and address underlying cause e.g. medication induced
2) Lifestyle measures
- increase fibre/fluids/activity
3) Pharmacological management
- Bulk forming laxative= 1st line
- if stools remain hard then osmotic laxative e.g. macrogol
- if macrogol not tolerated or ineffective then lactulose
- if stools soft but difficult to pass then stimulant e.g senna

Question 3

What is the management of chronic constipation > 3 months?

Answer 3

Investigate secondary causes and manage similar to short constipation

Consider
- opioid induced constipation- avoid bulk forming and use osmotic or stimulant (or docusate)
- Faecal impaction
– hard stools- high dose macrogol and add stimulant if needed
– soft stools consider bisacodyl suppository or mini enema if oral treatment fails