Gastrointestinal pathologies Flashcards
Most cases of constipation can be described as idiopathic constipation or functional constipation, meaning there is not a significant underlying cause other than simple lifestyle factors. It is important to think about possible secondary causes of constipation, such as:
- Hirschsprung’s disease
- Cystic fibrosis
- Hypothyroidism
- Spinal cord lesions
- Sexual abuse
- Intestinal obstruction
- Anal stenosis
- Cows milk intolerance
Typical features in the history and examination that suggest constipation are:
- Less than 3 stools a week
- Hard stools that are difficult to pass
- Rabbit dropping stools
- Straining and painful passages of stools
- Abdominal pain
- Holding an abnormal posture, referred to as retentive posturing
- Rectal bleeding associated with hard stools
- Faecal impaction causing overflow soiling, with incontinence of particularly loose smelly stools
- Hard stools may be palpable in abdomen
- Loss of the sensation of the need to open the bowels
What is encopresis and what is it normally a sign of?
Encopresis is the term for faecal incontinence. This is not considered pathological until 4 years of age. It is usually a sign of chronic constipation where the rectum becomes stretched and looses sensation. Large hard stools remain in the rectum and only loose stools are able to bypass the blockage and leak out, causing soiling.
Rarer causes of encopresis
- Spina bifida
- Hirschprung’s disease
- Cerebral palsy
- Learning disability
- Psychosocial stress
- Abuse
There are a number of lifestyle factors that can contribute to the development and continuation of constipation:
- Habitually not opening the bowels
- Low fibre diet
- Poor fluid intake and dehydration
- Sedentary lifestyle
- Psychosocial problems such as a difficult home or school environment
Red flags for constipation
- Not passing meconium within 48 hours of birth
- Neurological signs or symptoms, particularly in the lower limbs
- Vomiting
- Ribbon stool
- Abnormal anus
- Abnormal lower back or buttocks
- Failure to thrive
- Acute severe abdominal pain and bloating
What could not passing meconium within 48 hours of birth indicate?
Cystic fibrosis or Hirschsprung’s disease
What could neurological symptoms (particularly in the lower limbs) with constipation indicate?
Cerebal palsy or spinal cord lesion
What could vomiting with constipation indicate?
Intestinal obstruction or Hirschsprung’s disease
What could ribbon stool indicate?
Anal stenosis
What could an abnormal anus with constipation indicate?
Anal stenosis, inflammatory bowel disease or sexual abuse
What could abnormal back or buttocks with constipation indicate?
Spina bifida, spinal cord lesion or sacral agenesis
What could failure to thrive with constipation indicate?
Coeliac disease or hypothyroidism
What could acute severe abdominal pain with constipation indicate?
Obstruction or intussuception
Complications of constipation
- Pain
- Reduced sensation
- Anal fissures
- Haemorrhoids
- Overflow and soiling
- Psychosocial morbidity
