constipation and change in bowel habit

commoncauses: depression,immobility, idiopathic, Functional, inadequate dietary fibre

rarea) metabolic: 1) Hypothyroidism, 2)Hypercalcaemia b)Drugs: 1)opiates, 2)Antidepressants, 3)Verapamil and other ca2+ blockers c)Neoplasia: 1)colon cancaer 2) Rectal cancer

clinical features1) period of constipation , 2)Has the nature of the problem change 3) history 4)rectal bleeding 5)Dietary history 6) Drug history

E & Ia)blood test: 1)FBC, 2)ESR 3)thyroid function and calcium b) Barium Enema or CT colonography, c)Transit studies d)Anorectal physiology and defecating proctography

Managementsa) for reassurance b)Diet and hydration c)Laxatives= 1)stimulant laxative 2)bulk-forming laxative 3)osmotic laxative*

IN OLDER PATIENTS Features suggestive of underlying pathlogy Examination Management 1)Anorexia and/weight loss 2)Nocturnal Diarrhoea /pain disturbing sleep 3)rectal bleeding full physical examination mandatory, - lymphadenopathy, abdominal masses, organomegaly , rectal examination Serious disease is sought from FBC, ESR iron indices, LFTs, Thyroid function, serum calcium. TO eliminate suspicion of colorectal cancer : colonoscopy, barium enema, ct colonography

History  obstetric in women, pelvic trauma during protracted labour,assisted delivery  Drug history- opioids,calcium antagonist, anticholinergics, iron supplements, calcium containing antacids

Stimulant laxative eg. SENNA , use for short term constipation due to dependant on drugs (especially during hospitalisation) ~bulk forming laxatives eg. FYBOGEL,ISOGEL. may exacerbate symptomatic bloating ~osmotic laxative (e.g MOVICOL, MgSo4) well tolerated, first line treatment over country tablets such as milk of magnesia, epsom salt, lactulose (may cause inconvenient colic and wind

often unrewarding

notes

Annotations