Constipation

SuP4 Surgical emergencies MRCEM syllabus , GP4 Gastro HPB MRCEM syllabus

	Formal definition: ≥3/12 with straining with defaecation, sensation of incomplete defaecation >25% of the time, <2 bowel movements a week, lumpy/hard stools >25% of the time
History	➥ clarify "diarrhoea", "constipation" etc. ➥ Duration, frequency, consistency of stools ➥ associated rectal/gynae/urinary/abdo s/s ➥ Diet, fibre intake, toileting routines, continence, mobility ➥ DHx including OTC already tried eg for constipation ➥ Ask about IBS s/s - bloating, alternating diarrhoea and constipation ➥ autonomic neuropathy, anorectal disorders
Examination	weight loss? Rectal o/e: faecal impaction
Diagnostic investigations	Depending on clinical context, FBC, TFTs, CA-125 ➥ Faecal calprotectin if clinically suspicious for inflammatory bowel disease
Differentials
Immediate management	Exclude Bowel obstruction
Ongoing management	➥ Drug review ➥ Laxatives: bulk-forming/osmotic to soften -> stimulant + drink plenty of fluids ➥ Irritable bowel syndrome: alternating constipation and diarrhoea; loperamide might have role

Constipation in children is a slightly different beast

Drugs commonly causing constipation