CONSTIPATION

Water and salts reabsorbed, resulting in drying Bacteria  ferment non-digestible polysaccharides, some metabolites absorbed  produce Vitamin K and Biotin (Vit B7), which can be absorbed Produce gases from undigested polysaccharides  Essential for development of caecum and lymphatics Stored in rectum until urge for defecation

Food passes from small intestine and passes along caecum, colon and into rectum by peristalsis. Stored in rectum until urge for defecation Stools hard when stored in rectum for longer than normal so more water absorbed

“The passage of hard stools (faeces) less frequently than the patient’s own normal pattern”  Chronic constipation – generally >12 weeks in preceding 6 months

F- Symptom

 Difficulty in opening bowels  Going <3 times per week  Straining to open bowels more than 25% of occasions  Hard or pellet-like stool on more than 25% occasions

Chronic constipation – generally >12 weeks in preceding 6 months

Common, affects all ages  1 in 7 adults  1 in 5 older people  1 in 3 children  Late pregnancy  Taking regular medicines

More common in women

10 Million

Age Diet Poor bowel habits (ignoring urge to defecate) Imaginary Constipation Medications Laxative abuse IBS Intestinal obstruction Mechanical Ps Anus and rectum, poor thyroid function, lead poisoning, pregnancy ,travel, immobility.

Diet  Low fibre  High animal fat  Inadequate fluid intake  Caffeine  Alcohol

Antacids – Al and Ca salts  Antispasmodics  Antidepressants – eg amitriptyline, doxepin  Iron tablets eg ferrous sulphate  Diuretics  Painkillers – eg codeine, morphine  Ca channel blockers eg diltiazem, verapamil  ACE inhibitors eg enalapril, lisinopril  Anticholinergic eg hyoscine, tolterodine  Ulcer healing eg lansoprazole, omeprazole  Antipsychotics eg haloperidol, olanzipine

Intestinal obstruction  Scarring – from IBD, diverticulitis or post surgery Adhesions  Intestinal cancers  Abdominal hernia  Gallstones wedged in intestine  Volvolus  Foreign bodies  Intussusception  Haemorrhoids  Fissures

 Diabetic autonomic neuropathy  Spinal cord injury or tumors  Cerebrovascular accident  Multiple sclerosis  Parkinson’s disease  Connective tissue disorders  Hirschsprungs disease

TRUE

Medical history History of symptoms  Normal patterns of defecation  Other symptoms  Frequency and consistency, faecal impaction, incontinence  How long/intense are the symptoms?  Impact on daily life Medications Changes in diet and lifestyle  Change jobs  Holidays  Diet

Prevalent in 5-30% children Aetiology often unknown

Symptoms:  Infrequent bowel activity  Foul smelling wind and stools  Excessive flatulence  Irregular stool texture  Abdominal pain, distension or discomfort  Soiling/overflow

Main causes:  Age-related decline in GI motility  Decreased mobility  Poor diet – low solid and liquid intake  Wasting of pelvic floor muscles  Side effects of medicines Faecal impaction may occur

o Lifestyle and dietary changes o Short course of laxatives

• Achieve an individual’s normal frequency of defecation • Establishing regular, comfortable defecation • Preventing laxative dependence • Relieving discomfort

• Bulking agents • Stimulant Laxatives • Faecal Softeners • Osmotic Laxatives

• Ispaghula husk: -Cannot take before bed, ensure good fluid intake and it remains effective despite long-term use. • Methylcellulose: 500mg tablets . 3-6 tablets BD with at least 300ml of water - Break tablets in the mouth before swallowing - Cannot take before bed -Ensure good fluid intake -2-3 days for effect

Docusate (oral and rectal) Glycerol (suppository) Arachis oil (enema)